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New Hampshire PRAMS Maternal & Child Health Section Division of Public Health Services Department of Health & Human Services 29 Hazen Drive Concord, NH 03301-6504 [email protected] 1-800-852-3345 x2081

2013 - 2015 Data Book Stratified by Birth Weight

July 2018 (v.1.0)

mailto:[email protected]

This publication was made possible by grant #5U01DP003156 from the Centers for Disease Control and Prevention.

Suggested citation for this report: New Hampshire Department of Health and Human Services, Division of Public Health Services, Maternal and Child Health Section, Pregnancy Risk Assessment Monitoring System (PRAMS), 2013-2015.

Disclaimer: The findings and observations in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

New Hampshire

Pregnancy Risk Assessment

Monitoring System (PRAMS)

2013-2015 Data Book Stratified by Birth Weight

Lisa Morris, MSSW, Director, Division of Public Health Services Rhonda Siegel, M.Ed., Administrator, Maternal & Child Health Section

PRAMS Team: Paulette Valliere, MPH, PRAMS Project Director

David Laflamme, PhD, MPH, MCH Epidemiologist Sara Riordan, M.Ed., PRAMS Project Coordinator

Misty Batchelder, PhD, PRAMS Project Data Manager

July 2018 (v.1.0)

New Hampshire PRAMS 2013-2015 Data Book Stratified by Birth Weight 2

ACKNOWLEDGMENTS The New Hampshire PRAMS Project Team would like to acknowledge the CDC PRAMS team for their technical assistance and support, namely our project officers Denise D’Angelo and Megan O’Connor, and statisticians Phil Hastings and Brian Morrow. Thanks also to the New Hampshire Division of Vital Records Administration, and notably Data Entry Operator Wendy Kizer, for ongoing diligence in ensuring completeness of the sampling frame. Within the New Hampshire Department of Health and Human Services, Division of Public Health Services, we thank statistician Dr. Michael Laviolette in the Bureau of Health Statistics and Informatics for his able assistance. Thanks also to the NH PRAMS Steering Committee for their ongoing guidance and support. Sincere thanks and appreciation also go to the New Hampshire women who participated in PRAMS, for sharing their experiences and allowing us to use this information. Contact Information: PRAMS Team Maternal & Child Health Section Division of Public Health Services NH Department of Health and Human Services 29 Hazen Drive, Concord, NH 03301 Telephone: 603-271-2081 Email: [email protected] This publication can be downloaded from the DHHS website: http://www.dhhs.nh.gov/dphs/bchs/mch/prams/prams-pubs.htm Data can also be requested from this website. For more information on the national PRAMS project see: http://www.cdc.gov/PRAMS/index.htm


http://www.dhhs.nh.gov/dphs/bchs/mch/prams/prams-pubs.htm

http://www.cdc.gov/PRAMS/index.htm


Executive Summary Since 2013, New Hampshire’s Pregnancy Risk Assessment Monitoring System (PRAMS) has been collecting statewide data from resident women who have a live birth, within two to six months after giving birth. Topics include maternal behaviors, attitudes and experiences just prior to the pregnancy, during pregnancy, and shortly after delivering their baby. This data book compares the answers of women who have a low birth weight baby with those who have a normal (or higher) birth weight baby for births occurring 2013-2015. It is important to note that these comparisons may show differences between groups that could change (weaken, strengthen, disappear or reverse) if other factors were considered at the same time. The purpose of this report is to make the data available in a way that encourages further exploration of these relationships. Interested researchers may request de-identified data using the forms linked on the NH PRAMS website. Smoking tobacco during pregnancy is well-known to have detrimental impacts on birth outcomes including birth weight. Among NH births, smoking was more frequent in the low birth weight group, in all perinatal time periods: two years before the pregnancy, three months before the pregnancy, in the last trimester, and at the time of the survey (postpartum). A larger percentage of women who had a low birth weight baby were in the lower income group and in the lowest education group, than women with a normal birth weight baby. Socioeconomic status is strongly related to health outcomes through a variety of factors such as access to health services, physical environment and complex differences in the social and economic structures of our society. These factors, often referred to as the social determinants of health, are a source of health inequities. Differences in breastfeeding were also noted, with fewer women in the low birth weight group breastfeeding more than eight weeks, and also fewer breastfeeding at the time of survey (2-6 months postpartum). The most frequently cited reason among all women for breastfeeding discontinuation was not producing enough milk. Around half of the women with a low birth weight baby reported having had a postpartum home visitor. Postpartum depression was reported by nearly one in five women with a low birth weight baby, compared to approximately one in ten women with a normal birth weight baby. More summary information can be found in the Summary Highlights section, and the data tables at the end of this report contain detailed information.


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New Hampshire PRAMS Pregnancy Risk Assessment Monitoring System 2013-2015 Data Book Stratified by Birth Weight

PURPOSE The purpose of this report is to provide a quick reference to basic findings that researchers and practitioners may find useful when deciding whether to further investigate any of these indicators related to pregnancy.

INTRODUCTION The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of the Centers for Disease Control and Prevention (CDC) conducted through cooperative agreements with state health departments. PRAMS collects state-specific, population-based data on maternal attitudes and experiences shortly before, during, and shortly after pregnancy. The goal of the PRAMS project is to improve the health of mothers and infants by reducing adverse outcomes such as low birth weight, infant morbidity and mortality, and maternal morbidity. Initiated in 1987 as part of the CDC’s initiative to reduce infant mortality and low birth weight, in the period 2013-2015 PRAMS was active in 40 states plus New York City, representing 78% of all US live births. Because all participating states follow a standard protocol and ask identical Core Questions, results can be compared across states as well as aggregated into a national snapshot of maternal and infant health. Findings from PRAMS are used to enhance understanding of maternal behaviors and their relationship with adverse pregnancy outcomes. PRAMS data are also used to plan and evaluate health programs and to inform policymakers and the general public. NH PRAMS collects data on several factors pertaining to Title V Maternal and Child Health priorities, including access to health care, substance use or misuse, and safe sleep practices.

METHODOLOGY Sampling and Data Collection PRAMS-eligible women are all New Hampshire residents who have a live birth. Approximately one in 12 New Hampshire-resident women are randomly sampled between two and six months after giving birth. New Hampshire includes out-of-state births to New Hampshire residents in the sampling plan due to the high proportion of births occurring out-of-state (8.4% in 2013; 9.2% in 2014; 9.0% in 2015) and their potentially higher risk profile: women may go out of state in order to utilize a higher level of care when this is closer to their home than higher level care in New Hampshire. The annual PRAMS samples of women who have had a recent live birth are drawn from the State's birth certificate file. New Hampshire PRAMS samples approximately 1,000 women per year. Each month, a random


sample is drawn of approximately 85 women who had a live birth; the sample is stratified by birth weight, with women having a low birth weight baby (less than 5.5 pounds) sampled at a higher rate to ensure adequate data are available from this smaller, but higher risk population. In this report, very low and low birth weights are grouped together (LBW), and the normal and high birth weights comprise the second, comparison group (NBW), with 5.5 pounds as the demarcation between the two groups. Data collection procedures and instruments are standardized to allow comparisons between states as well as multi-state analyses. All states administer a group of Core Questions, and states select their own Standard Questions according to their needs and priorities. States may also write their own state-specific questions; New Hampshire-specific questions in the Phase 7 survey (2013-2015) covered arsenic in well water, use of text messaging, and use of social media for information on pregnancy issues. After a sample is drawn, a series of mailings is implemented over the next six weeks. The PRAMS questionnaire contains items asking about the early postpartum period; thus, the mailings are timed to ensure that all women will be able to respond for this timeframe. The first mailing is a letter to introduce PRAMS to the mother and to inform her that a questionnaire will follow. Five days later, a questionnaire packet is mailed. This packet contains the 75-item survey booklet plus an informed consent document, calendar, resource list, and a coupon for a birth certificate as a reward for completion of the survey. Ten days after the initial packet is mailed, a tickler serving as a thank you and reminder note is sent. Mothers who did not return their questionnaire in the next two weeks are sent a second questionnaire packet. All remaining non-respondents are mailed a third questionnaire packet two weeks after the second. After the mailings, a series of telephone calls are made to all women who did not return a mailed survey; over the next four weeks up to 15 attempts are made to contact each woman. Telephone calls are made at various times of the day and on different days of the week. Call-back interviews are arranged as needed to accommodate the mother’s schedule. The full data collection cycle from the mailing of the pre-letter to the end of telephone follow-up is 85 days. Survey Results and Data Analysis The CDC recommends that states obtain a response rate of at least 60% for analysis of PRAMS data. New Hampshire’s weighted response rates were 67% in 2013, 64.0% in 2014, and 62% in 2015, representing a three-year total of 36,340 resident births; of these, the weighted frequency estimate for low birth weights was 2,065 and for normal birth weights 34,275. Data collected through PRAMS are linked to birth certificate data, which allows the survey data to be weighted to reflect the total birth population and not just the survey respondents. Sampling, non-response and non-coverage weights are applied to the data in order to make the results generalizable to the State’s entire population of women delivering live born infants during each study period (one calendar year). Population estimates are obtained by using the analysis weights and survey design variables. Analysis was done using SAS survey analysis procedures for complex survey design (version 9.4). Interpretation of text and tables A combined three-year percentage estimate is reported for each indicator in the PRAMS survey. In addition, annual percentage estimates are provided for indicators for which the annual confidence intervals showed a significant difference by year, within either the low birth weight (LBW) group or the normal/high birth weight (NBW) group.


Because of the survey design, a margin of error is computed, which is the 95% confidence interval (CI). A 95% CI indicates 95% certainty that the true (unknown) population value is included within this range. Data are suppressed and represented with an asterisk (*) when the sampled number of ‘Yes’ responses was less than ten, or when the relative standard error of the estimate is large (>= 30% of the estimate), which indicates that the estimate has high variability and is unreliable.

LIMITATIONS The PRAMS survey is subject to limitations. Non-response bias may be present if the sampled women who did not participate were systematically different from those who did and if the weighting process did not fully account for this. PRAMS data are self-reported and may be subject to social desirability bias or inaccuracies, leading to reporting bias. The questionnaire is administered two to six months after the birth occurs, so recall bias should be limited but cannot be excluded. Mode bias also is possible if mothers answer differently depending on whether they completed the mail survey or the telephone survey. The survey is available only in English, so mothers with limited English proficiency may not be able to participate. This data book presents findings stratified by birth weight (LBW, defined as low or very low vs. NBW, defined as normal or high). The findings show simple associations between various indicators and the birth weight outcomes, and are not intended to imply causal relationships. Causation cannot be considered without examining the effects of possible confounders such as plurality, preterm birth, small for gestational age, previous births (if any), maternal age, education, socioeconomic status, and the content and/or frequency of prenatal care, to name a few. Causation and the role of confounders are beyond the intended scope of this data book.


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Summary Highlights These bullet points provide an overview of the findings on various indicators. They are not an exhaustive summary of all findings; rather, they focus on some indicators that show a significant difference between the LBW group and the NBW group. These differences may not be valid upon adjustment for confounders. They also may not have clinical significance. The reader should refer to the data tables in the body of the report for more complete information; data points that are not featured in this summary section may still be of interest. NB: Each bullet point cites the question to which it refers; e.g., [Q1] = summary finding from Question 1. Pre-pregnancy

• There were no significant differences in the BMI groupings or age groupings of the women who had a low birth weight baby compared with those who had a normal birth weight baby. [Q2, Q3]

• Having had a previous live birth was proportionately more common among women who had a normal birth weight baby (54.8%) than among those who had a low birth weight baby (47.8%). [Q4]

• Conversely, having had a previous low birth weight baby was proportionately more common among women giving birth to a low birth weight baby (26.1%) than among women who had a normal birth weight baby (8.7%). [Q5]

• Likewise, having had a previous preterm birth was proportionately more common among women who had a low birth weight baby (23.6%) than among those who had a normal birth weight baby (12.1%). [Q6]

• Health-related behaviors: Women who had a low birth weight baby, compared with those who had a normal birth weight baby, reported less dieting and exercise before pregnancy, and more instances of getting checked for diabetes, high blood pressure or depression. [Q7]

• Women who had a low birth weight baby reported less insurance coverage from work, and more Medicaid coverage (59.5%, 17.5%), than women who had a normal birth weight baby (66.1%, 11.5%). [Q8]

• Women who had a low birth weight baby reported proportionately more diagnoses of high blood pressure and depression (8.5%, 21.9%) than women who had a normal birth weight baby (3.1%, 15.8%). [Q11]

• There were no differences in pregnancy intendedness between the two groups [Q12], nor in whether or not they were trying to conceive. [Q14]

During Pregnancy

• Among women who had a low birth weight baby, proportionately fewer had a Kotelchuck score (adequacy of prenatal care utilization, based on initiation of care and the number of visits) of ‘Adequate’ (19.3%) and more had a Kotelchuck score of ‘Adequate plus’ (68.7%) than the women who had a normal birth weight baby (47.5% Adequate; 38.7% Adequate plus). [after Q18]

• Women who had a low birth weight baby reported getting prenatal care as early as they wanted less often (83.3%) than women who had a normal birth weight baby (88.6%). [Q19]


• The most frequently cited reason for not getting early prenatal care was not knowing that she was pregnant, reported by 53.1% of women who had a low birth weight baby, and by 38.6% of women with a normal birth weight baby. [Q20]

• Among women who had a low birth weight baby, 58.4% reported that their prenatal care was paid by health insurance from work, and 38.6% by Medicaid; for women who had a normal birth weight baby, these figures were 65.5% from work and 30.7% from Medicaid. [Q21]

• Between the two birth weight groups, there were several significant differences reported in the content of information received during prenatal care visits, such as information about the effects of smoking on the baby, or information on breastfeeding. [Q22]

• 20.9% of women with a low birth weight baby took childbirth classes, compared to 25.6% of women with a normal birth weight baby. [Q28]

• A significantly larger percentage of women in the LBW group were enrolled in WIC during pregnancy, than women in the NBW group (34.9% vs. 27.2%). [Q31]

• Gestational diabetes was reported by a larger percentage of women in the LBW group than in the NBW group (11.0% vs. 7.7%). [Q31]

• Smoking in the two years before pregnancy was reported by 40.5% of women who had a low birth weight baby, and by 25.5% of women who had a normal birth weight baby. [Q32]

• 33.8% of women in the LBW group and 22.9% of women in the NBW group reported smoking in the three months just before the pregnancy. [Q33]

• 23.2% of those in the LBW group and 10.3% of those in the NBW group smoked in the last three months of pregnancy. [Q34]

• 27.1% of those in the LBW group and 13.7% of those in the NBW group reported smoking at the time of the survey (2-6 months after giving birth). [Q35]

• There was no significant difference in rates of drinking alcohol in the previous two years between women who had a low birth weight baby (78.9%) and those who had a normal birth weight baby (80.5%). [Q36]

• However, women who had a low birth weight baby reported less drinking in the three months before pregnancy than women in the normal birth weight group (66.6% vs. 71.7%). [Q37]

• Women who had a low birth weight baby also reported less drinking in the last three months of pregnancy (6.8% vs. 11.5%). [Q38]

• Several significant differences in rates of stressors experienced during pregnancy were reported, with women having had a low birth weight baby reporting higher rates than women having had a normal birth weight baby, in each instance. [Q39]

• Rates of intimate partner violence were higher among women who had a low birth weight baby than those who had a normal birth weight baby: 3.9% vs. 2.1% before pregnancy, and 3.8% vs. 1.2% during pregnancy. [Q40, Q41]

• In both groups of women, approximately 40% reported having their labor induced; among women with a low birth weight baby the most frequently cited reason was a pregnancy complication (45.4%, vs. 16.8% among women in the NBW group); the most often cited reason among women with a normal birth weight baby was being past the due date (35.2%; for women in the LBW group this data point was too small to report). [Q44]


• There were several significant differences reported in health care worker advice regarding smoking between women who ultimately had a low birth weight baby and those who had a normal birth weight baby. [Q68]

Postpartum

• 57.1% of babies of low birth weight were placed in an intensive care unit (NICU), compared to 6.4% of babies of normal birth weight. [Q46]

• 100% of LBW babies and 99.7% of NBW babies were alive at the time of survey. [Q48]

• Among all women (not just those who initiated breastfeeding):

46.6% of those who had a low birth weight baby were breastfeeding at the time of survey (2-6 months postpartum), compared with 57.1% of those who had a normal birth weight baby. [Q51]

57.1% of those who had a low birth weight baby breastfed more than 8 weeks, compared with 63.9% of those who had a normal birth weight baby [Q52]

• Among all women who initiated but had stopped breastfeeding by the time of survey, the most frequently cited reason for discontinuation was not producing enough milk: 55.9% among those with a low birth weight baby, and 49.6% of those with a normal birth weight baby (no statistically significant difference between LBW and NBW groups). [Q53]

• Other reasons cited for discontinuation (with a statistically significant difference) were that milk didn’t satisfy baby (27.9% in LBW group, 43.5% in NBW group), and sore nipples (9.7% in LBW group, 29.7% in NBW group). [Q53]

• There were several statistically significant differences between groups in hospital norms, hospital staff behavior or teaching, and health care worker advice or instruction. [Q54, Q55]

• Approximately half of women with a low birth weight baby (50.7%) and nearly one-third of women with a normal birth weight baby (31.0%) had a home visitor postpartum. [Q57]

• A smaller percentage of women with a low birth weight baby were using postpartum contraception than women with a normal birth weight baby (76.8% vs. 82.7%). [Q58]

• Proportionately fewer women who had a low birth weight baby had a postpartum checkup than women who had a normal birth weight baby (88.7% vs. 93.2%). [Q61]

• A combined measure of postpartum depression shows that 18.8% of women who had a low birth weight baby scored positive for depression, compared to 11.0% of women who had a normal birth weight baby. [Q62, Q63]

• Postpartum, a smaller percentage of women in the LBW group compared to the NBW group had insurance from work (56.0% vs. 63.1%), and a larger proportion were enrolled in Medicaid (29.2% vs. 21.7%). [Q64}


Other points

• Home safety: A higher proportion of women who had a low birth weight baby than those who had a normal birth weight baby reported knowing infant CPR (67.7% vs. 62.6%), and having the poison control phone number accessible in their homes (76.9% vs. 72.0%). [Q69]

• A smaller percentage of women who had a low birth weight baby always used a seatbelt during pregnancy, than women who had a normal birth weight baby (78.9% vs. 85.8%). [Q69]

• Among women who had a low birth weight baby, co-sleeping with the new baby was reported by 23.1% “Sometimes” and by 26.1% “Rarely”; among women who had a normal birth weight, these data points were 17.2% “Sometimes,” and 30.5% “Rarely.” [Q70]

• There was no significant difference in the use of text messaging between both groups of women (approximately 95% each). [Q71]

• 49.1% of women who had a low birth weight baby were in the category of 0-185% of the Federal Poverty Level, compared to 40.7% of women who had a normal birth weight baby. [Q73, Q74]

• 60.5% of women who had a low birth weight baby were married, compared to 65.5% of women who had a normal birth weight baby.

• Among women who had a low birth weight baby, 11.6% had less than 12 years of education, and 65.4% had more than 12 years of education; among women who had a normal birth weight baby, these figures were 6.5% (less than 12 years) and 71.4% (more than 12 years).

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New Hampshire 2013-2015 Survey Topics and Questions (Phase 7)

Alcohol and drug use Question

Alcohol Any alcohol use in the past 2 years ….………………………………………………………………. 36 Alcohol use in the 3 months before pregnancy ………………………………………………… 37 Alcohol use in the last trimester of pregnancy …………………………………………………. 38 Advice during prenatal visits regarding effects of alcohol on baby …………………… 22d Illegal drugs Prenatal care health worker informed how illegal drugs could affect baby ……… 22g

Breastfeeding Advice Question

Breastfeeding advice during prenatal care ……………………………………………………….. 22c Breastfeeding advice at birthing hospital …………………………………………………………. 54a Hospital staff helped me learn how to breastfeed …………………………………………… 54c Hospital staff advised to breastfeed whenever baby wanted …………………………… 54g Hospital gave a breast pump to use …………………………………………………………………. 54h Hospital gave a gift pack with formula ……………………………………………………………… 54i Hospital gave a phone number to call for help with breastfeeding ………………….. 54j Hospital staff gave my baby a pacifier ……………………………………………………………… 54k After birth, health care worker offered help or information about breastfeeding 55a

Breastfeeding Behaviors Question

Breastfed in first hour after baby was born ………………………………………………………. 54d Breastfed in the hospital ………………………………………………………………………………….. 54e Baby fed only breast milk at the hospital …………………………………………………………. 54f Ever breastfed or pumped breast milk ……………………………………………………………… 50 Currently breastfeeding or pumping breast milk ………………………………………………. 51 Duration of breastfeeding ………………………………………………………………………………… 52 Reasons for discontinuation of breastfeeding ………………………………………………….. 53

Contraception Question

Use or non-use prior to recent pregnancy ………………………………………………………… 15 Reasons for non-use prior to recent pregnancy ……………………………………………….. 16 Method used prior to most recent pregnancy ………………………………………………….. 17 Use or non-use postpartum ……………………………………………………………………………… 58 Reasons for non-use postpartum ……………………………………………………………………… 59 Method used postpartum ………………………………………………………………………………… 60 Postpartum contraceptive advice from health care workers ……………………………. 55c

Diabetes Question

Preconception diabetes screening …………………………………………………………………… 7d Pre-pregnancy type 1 or type 2 diabetes …………………………………………………………. 11a Gestational diabetes ……………………………………………………………………………………….. 31

Diet and physical activity Question

Preconception dieting to lose weight ……………………………………………………………….. 7a Preconception physical activity 3x per week ……………………………………………………. 7b

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Domestic violence Question

Discussion by prenatal care health workers of physical violence ……………………. 22l Pre-pregnancy physical violence by partner ……………………………………………………. 40 During pregnancy, physical violence by partner ……………………………………………… 41

Drinking water contamination — Arsenic Question

Testing well water before birth of baby ……………………………………………………………. 65 Health care worker advice to test well water …………………………………………………… 66 Testing for arsenic in well water done ……………………………………………………………… 67

Flu Vaccine Question

12 months before birth of baby, health care worker advised flu vaccine …………. 24 12 months before birth of baby, received flu vaccine ………………………………………. 25 Month and year of flu vaccine ………………………………………………………………………….. 26

Head trauma Question

Health care worker informed what happens if baby is shaken …………………………. 55h

HIV Question

Prenatal advice by health care worker to get tested for HIV …………………………….. 22j During pregnancy, obtained HIV test ……………………………………………………………….. 23

Home visiting Question

Prenatal home visitor ………………………………………………………………………………………. 29 Postpartum home visitor ………………………………………………………………………………….. 57

Immunization — see Flu Vaccine

Infant Status Question

Infant in NICU …………………………………………………………………………………………………… 46 Infant alive now ……………………………………………………………………………………………….. 48 Infant living with mother now ………………………………………………………………………….. 49

Insurance Question

Type of insurance, pre-pregnancy ……………………………………………………………………. 8 Type of insurance for prenatal care ………………………………………………………………….. 21 Type of insurance postpartum …………………………………………………………………………. 64 Insurance for dental care during pregnancy ……………………………………………………… 27d Insurance not accepted by prenatal health care provider ………………………………… 20l

Labor and delivery Question

Labor induced ………………………………………………………………………………………………….. 43 Reasons for labor induction ……………………………………………………………………………… 44 NICU admission ………………………………………………………………………………………………… 46 Length of hospital stay ……………………………………………………………………………………… 47

Life stressors Question

Various life stressors (illness, divorce, lost job, etc.) ………………………………………… 39a-n

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Maternal characteristics Question

Age group ………………………………………………………………………………………………………… 3 Pre-pregnancy BMI …………………………………………………………………………………………… 1, 2 Weight gain during pregnancy …………………………………………………………………………. 45

Mental Health Question

Pre-pregnancy depression check ……………………………………………………………………… 7f Pre-pregnancy depression diagnosis ………………………………………………………………… 11c Prenatal health worker advice on depression …………………………………………………… 22k Health care worker advice about postpartum depression ………………………………… 55d Health care worker advice about emotional pain …………………………………………….. 55j Feeling down, depressed or hopeless ………………………………………………………………. 62 Little interest or pleasure in doing things …………………………………………………………. 63

Nutrition Question

Preconception use of vitamins or folic acid ………………………………………………………. 9

Oral health Question

Preconception teeth cleaning …………………………………………………………………………… 7h Oral health care during pregnancy (knowledge, services, need) ………………………. 27a-f

Postpartum health care Question

Postpartum checkup ………………………………………………………………………………………… 61 Postpartum advice (various topics) from health care workers …………………………. 55a-j Postpartum home visitor ………………………………………………………………………………….. 57

Preconception morbidities Question

Prescription medication …………………………………………………………………………………… 7c Hypertension screening …………………………………………………………………………………… 7e Hypertension diagnosis ……………………………………………………………………………………. 11b Health care worker asked about family medical history …………………………………… 7g Health care worker advice to improve health …………………………………………………… 10

Pregnancy history Question

Previous live birth …………………………………………………………………………………………….. 4 Previous low birth weight birth ………………………………………………………………………… 5 Previous preterm birth ……………………………………………………………………………………. 6

Pregnancy intention Question

How did you feel about becoming pregnant …………………………………………………….. 12 How much longer did you want to wait to become pregnant …………………………… 13 Were you trying to get pregnant ………………………………………………………………………. 14 Husband or partner said he didn’t want you to be pregnant ……………………………. 39j

Prenatal care Question

Timing of first prenatal care visit ……………………………………………………………………… 18 Started prenatal care as early as you wanted …………………………………………………… 19 Barriers to prenatal care …………………………………………………………………………………… 20a-l Discussion topics by prenatal care health providers …………………………………………. 22a-l

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Help or advice to quit smoking by prenatal care health providers …………………… 68a-k Classes to prepare for childbirth ………………………………………………………………………. 28 Home visitor to help you prepare for new baby ………………………………………………. 29

Pregnancy intention Question

How did you feel about becoming pregnant …………………………………………………….. 12 How much longer did you want to wait to become pregnant …………………………… 13 Were you trying to get pregnant ………………………………………………………………………. 14 Husband or partner said he didn’t want me to be pregnant …………………………….. 39j

Safety Question

In cars Always used a seatbelt during pregnancy …………………………………………………………. 69i New baby always rides in a rear-facing infant car seat ……………………………………… 69d In homes Various safety issues ………………………………………………………………………………………… 69a-i Arsenic in drinking water …………………………………………………………………………………. 65,66,67

Socioeconomic Status Question

Household income 12 months before baby was born ………………………………………. 73 Number of persons dependent on household income ……………………………………… 74 WIC participation during pregnancy …………………………………………………………………. 30

Sleep behaviors Question

Baby stayed in mom’s room at hospital ……………………………………………………………. 54b Infant sleep position ………………………………………………………………………………………… 56 Infant sleeps with others …………………………………………………………………………………. 70

Smoking Question

Smoking in past 2 years ……………………………………………………………………………………. 32 Smoking 3 months before pregnancy ………………………………………………………………. 33 Smoking last trimester ……………………………………………………………………………………… 34 Current smoking ………………………………………………………………………………………………. 35 Help or advice to quit smoking by prenatal care health providers …………………… 22b, 68a-k

Social media Question

Text messaging ………………………………………………………………………………………………… 71 Sources of information for pregnancy issues (traditional and social media) ……. 72a-l

Violence - see Domestic Violence

WIC Question

WIC participation during pregnancy ………………………………………………………………… 30

17 New Hampshire PRAMS 2013-2015 Data Book Stratified by Birth Weight

Before Pregnancy A combined three-year percentage estimate is reported for each indicator in the PRAMS survey. Additionally, annual percentage estimates are provided for indicators in which the yearly confidence intervals show a significant difference by year, within either the LBW group or the NBW group; where yearly differences occur, text is italicized and cells are shaded. NB: This data book presents findings stratified by birth weight (LBW, defined as low or very low vs. NBW, defined as normal or high). The findings show simple associations between various indicators and the birth weight outcomes, and are not intended to imply causal relationships. Causation cannot be considered without examining the effects of possible confounders such as plurality, preterm birth, small for gestational age, previous births (if any), maternal age, education, socioeconomic status, and the content and/or frequency of prenatal care, to name a few. Causation and the role of confounders are beyond the intended scope of this data book. 1. How tall are you without shoes? 2. Just before you got pregnant with your new baby, how much did you weigh? Woman’s height and weight are used to calculate BMI before pregnancy; BMI is calculated as weight in kilograms divided by the square of the height in meters (kg/m2). BMI Percent 95% CI Yes Population [MOM_BMIG_QX_REV] Yes Lower Upper Responses Estimate LBW (n=708)

Underweight, BMI 18.4 or less 4.7 3.6 6.2 34 95 Normal weight, BMI 18.5 to 24.9 53.5 50.4 56.5 377 1079

Overweight, BMI 25.0 to 29.9 20.5 18.1 23.1 145 414 Obese, BMI 30.0 or higher 21.3 18.9 23.9 152 430

NBW (n=1142) Underweight, BMI 18.4 or less 3.4 2.5 4.7 36 1161

Normal weight, BMI 18.5 to 24.9 50.0 47.1 52.9 575 16837 Overweight, BMI 25.0 to 29.9 24.7 22.3 27.3 287 8331

Obese, BMI 30.0 or higher 21.8 19.5 24.4 244 7361 3. What is your date of birth? (used to calculate mother’s age group) Age group Percent 95% CI Yes Population [calculated from MAT_AGE_NAPHSIS] Yes Lower Upper Responses Estimate LBW (n=724)

Under 20 4.9 3.8 6.4 35 101 Age 20 – 24 18.7 16.3 21.2 124 385 Age 25 – 29 26.8 24.2 29.6 193 554 Age 30 – 34 29.6 26.9 32.4 225 610 Age 35 – 39 15.7 13.6 18.0 117 323

Age 40 and older 4.4 3.2 5.9 30 90


NBW (n=1161) Under 20 4.5 3.4 6.0 44 1534

Age 20 – 24 18.8 16.6 21.3 198 6448 Age 25 – 29 28.7 26.1 31.4 323 9833 Age 30 – 34 31.7 29.2 34.4 394 10881 Age 35 – 39 12.8 11.0 14.7 160 4373

Age 40 and older 3.5 2.6 4.7 42 1207 4. Before you got pregnant with your new baby, did you ever have any other babies who were born alive? Had a previous live birth Percent 95% CI Yes Population [PREV_LB] Yes Lower Upper Responses Estimate LBW (n=717) 3-yr combined 47.8 44.8 50.9 323

LBW in 2013 (n=240) 42.0 37.0 47.2 101 267 LBW in 2014 (n=246) 48.1 43.0 53.3 116 339 LBW in 2015 (n=231) 52.7 47.3 58.1 106 371

NBW (n=1151) 3-yr combined 54.8 51.9 57.7 643 NBW in 2013 (n=394) 55.7 50.7 60.6 224 6365 NBW in 2014 (n=378) 52.7 47.7 57.7 203 5935 NBW in 2015 (n=379) 56.0 51.0 60.9 216 6310

5. Did the baby born just before your new one weigh 5 pounds, 8 ounces (2.5 kg) or less at birth? **Women who answered No to Q4 were instructed to skip this question. Had a previous low birthweight baby Percent 95% CI Yes Population [PREV_LBW] Yes Lower Upper Responses Estimate LBW (n=320) 26.1 22.2 30.4 81 252 NBW (n=640) 8.7 6.7 11.2 52 1607


6. Was the baby just before your new one born earlier than 3 weeks before his or her due date? **Women who answered No to Q4 were instructed to skip this question. Had a previous preterm birth Percent 95% CI Yes Population [PREV_PRE] Yes Lower Upper Responses Estimate LBW (n=321) 24.5 20.8 28.6 80 238 NBW (n=640) 12.1 9.8 14.9 76 2241


7. At any time during the 12 months before you got pregnant with your new baby, did you do any of the following things? Percent 95% CI Yes Population Yes Lower Upper Responses Estimate LBW (n=723) Diet to lose weight [PRE_DIET] 27.8 25.1 30.6 204 573 Exercise 3+ days/week [PRE_EXER] 50.9 47.9 53.9 378 1051 Regularly take prescription med [PRE_RX] 34.3 31.4 37.2 243 705 Get checked for diabetes [PRE_CKD] 19.3 17.0 21.8 139 397 Get checked for high BP [PRE_CKBP] 32.6 29.8 35.5 237 670

2013 check for HBP (LBW=242) 38.2 33.3 43.4 90 245 2014 check for HBP (LBW=247) 27.8 23.4 32.7 69 197 2015 check for HBP (LBW=232) 32.2 27.4 37.5 78 228

Checked for depression/anxiety [PRE_DEPR] 29.5 26.8 32.3 210 605 Talk to health care worker about family medical history [PRE_HIST] 42.9 39.9 45.9 311 881

Had teeth cleaned [PRE_DDS] 53.1 50.0 56.1 401 1095 NBW (n=1153) Diet to lose weight [PRE_DIET] 33.9 31.2 36.7 396 11535 Exercise 3+ days/week [PRE_EXER] 55.3 52.4 58.2 653 18896 Regularly take prescription med [PRE_RX] 26.8 24.4 29.5 308 9149 Get checked for diabetes [PRE_CKD] 14.3 12.4 16.5 168 4861 Get checked for high BP [PRE_CKBP] 22.4 20.1 24.9 265 7606

2013 check for HBP (NBW=392) 24.8 20.9 29.3 102 2818 2014 check for HBP (NBW=379) 19.2 15.6 23.4 75 2164 2015 check for HBP (NBW=379) 23.2 19.3 27.7 88 2625

Checked for depression/anxiety [PRE_DEPR] 22.2 19.9 24.7 256 7538 Talk to health care worker about family medical history [PRE_HIST] 40.0 37.3 42.9 469 13589

Had teeth cleaned [PRE_DDS] 63.0 60.1 65.7 748 21433


8. During the month before you got pregnant with your new baby, what kind of health insurance did you have? Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=724)

Insurance paid by job [INSWORK] 59.5 56.4 62.4 449 1228 Private, purchased insurance [INSCOMP] 1.9 1.2 2.8 15 39

Medicaid [INSMED] 17.5 15.2 20.0 115 361 Community health center or local

hospital program [INSGOV] 1.4 0.8 2.3 10 29

TRICARE or other military health [INSMIL] 1.5 0.9 2.5 11 31 Some other insurance [INSOTH] 4.0 2.9 5.4 28 82

Did not have insurance [INSNONE] 16.0 13.8 18.4 109 330


NBW (n=1161) Insurance paid by job [INSWORK] 66.1 63.3 68.8 792 22651

Private, purchased insurance [INSCOMP] 2.2 1.5 3.2 28 756 Medicaid [INSMED] 11.5 9.7 13.5 121 3936

Community health center or local hospital program [INSGOV] (*) (*) (*) (*) (*)

TRICARE or other military health [INSMIL] 1.3 0.8 2.1 16 453 Some other insurance [INSOTH] 4.0 2.9 5.3 42 1355

Did not have insurance [INSNONE] 15.3 13.3 17.5 165 5242

9. During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin? Multivitamin use Percent 95% CI Yes Population [VITAMIN] Yes Lower Upper Responses Estimate LBW (n=718)

Didn’t take vitamin 50.3 47.3 53.4 346 1030 1-3 times per week 4.6 3.5 6.1 33 95 4-6 times per week 6.3 5.0 7.9 48 128

Every day of the week 38.8 35.9 41.8 291 794 NBW (n=1150)

Didn’t take vitamin 45.6 42.7 48.5 499 15478 1-3 times per week 8.2 6.7 9.9 96 2778 4-6 times per week 7.9 6.5 9.5 95 2670

Every day of the week 38.4 35.6 41.2 460 13027


10. Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker talk to you about how to improve your health before pregnancy? Advice to improve health Percent 95% CI Yes Population [BPG_HLTH] Yes Lower Upper Responses Estimate

LBW (n=717) 27.3 24.7 30.1 201 559 NBW (n=1148) 23.9 21.5 26.4 282 8085 11. Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker tell you that you had any of the following health conditions? Percent 95% CI Yes Population


Diabetes [BPG_DIAB] 2.5 1.7 3.7 18 51 High blood pressure [BPG_HBP] 8.5 7.0 10.4 63 173

Depression [BPG_DEPRS] 21.9 19.5 24.6 151 447 NBW (n=1140)

Diabetes [BPG_DIAB] 2.2 1.5 3.2 25 739 High blood pressure [BPG_HBP] 3.1 2.3 4.3 37 1051

Depression [BPG_DEPRS] 15.8 13.8 18.1 174 5348


12. Thinking back to just before you got pregnant with your new baby, how did you feel about becoming pregnant? Percent 95% CI Yes Population [PGINTENT] Yes Lower Upper Responses Estimate LBW (n=715) I wanted to be pregnant later 18.2 15.9 20.7 126 371 I wanted to be pregnant sooner 16.3 14.2 18.6 121 332

2013 wanted sooner (LBW=238) 24.0 19.8 28.8 57 151 2014 wanted sooner (LBW=247) 10.5 7.8 14.0 27 74 2015 wanted sooner (LBW=230) 15.3 11.8 19.5 37 107

I wanted to be pregnant then 45.0 42.0 48.1 332 917 2013 wanted then (LBW=238) 39.5 34.5 44.7 96 248 2014 wanted then (LBW=247) 50.0 44.9 55.2 126 355 2015 wanted then (LBW=230) 45.0 39.6 50.5 110 314

I didn’t want to be pregnant 5.2 3.9 6.8 34 105 I wasn’t sure what I wanted 15.3 13.2 17.7 102 311 NBW (n=1141) I wanted to be pregnant later 20.1 17.8 22.6 215 6771 I wanted to be pregnant sooner 16.3 14.3 18.5 195 5484

2013 wanted sooner (NBW=388) 17.9 14.4 22.0 71 2007 2014 wanted sooner (NBW=375) 14.9 11.8 18.7 60 1667 2015 wanted sooner (NBW=378) 16.1 12.8 20.0 64 1811

I wanted to be pregnant then 45.0 42.2 47.9 528 15158 2013 wanted then (NBW=388) 44.7 39.8 49.7 178 5025 2014 wanted then (NBW=375) 44.9 40.0 50.0 173 5019 2015 wanted then (NBW=378) 45.4 40.5 50.4 177 5115

I didn’t want to be pregnant 5.1 4.0 6.6 55 1728 I wasn’t sure what I wanted 13.4 11.6 15.6 148 4524 13. How much longer did you want to wait to become pregnant? **Only women who answered “I wanted to be pregnant later” to Q12 were instructed to answer this question. Percent 95% CI Yes Population [PGWAIT] Yes Lower Upper Responses Estimate LBW (n=128)

Less than 1 year 16.9 12.3 22.8 23 64 1 year to less than 2 years 32.7 26.3 39.9 41 124

2 years to less than 3 years 25.6 19.8 32.5 32 97 3 years to 5 years 18.8 13.8 25.0 24 71

More than 5 years (*) (*) (*) (*) (*) NBW (n=211)

Less than 1 year 23.6 18.5 29.6 55 1568 1 year to less than 2 years 24.8 19.5 30.9 55 1646

2 years to less than 3 years 24.7 19.2 31.1 49 1638 3 years to 5 years 20.6 15.6 26.8 40 1370

More than 5 years 6.3 3.6 10.8 12 419


14. When you got pregnant with your new baby, were you trying to get pregnant? Trying to get pregnant Percent 95% CI Yes Population [PREG_TRY] Yes Lower Upper Responses Estimate LBW (n=715) 59.7 56.7 62.7 440 1217 NBW (n=1147) 58.1 55.2 61.0 691 19688 15. When you got pregnant with your new baby, were you or your husband or partner doing anything to keep from getting pregnant? **Women who answered Yes to Q14 were instructed to skip this question. Using birth control used when got pregnant Percent 95% CI Yes Population [BC_WHEN4] Yes Lower Upper Responses Estimate LBW (n=273) 36.4 31.8 41.3 102 296 NBW (n=450) 45.3 40.7 49.9 200 6333

16. What were your reasons or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant? **Women who answered Yes to Q15 were instructed to skip this question. Percent 95% CI Yes Population


Didn't mind getting pregnant [NBC_MIND] 47.5 41.5 53.5 91 262 Thought couldn't get pregnant at time

[NBC_TIME] 17.9 13.7 23.0 33 99

Had side effects [NBC_SIDE] 10.5 7.2 15.0 18 58 Had problems getting birth control [NBC_GET] (*) (*) (*) (*) (*)

Thought sterile [NBC_STER] 9.9 6.8 14.1 18 55 Husband/partner didn’t want to use [NBC_HUSB] 9.8 6.7 13.9 18 54

Forgot to use [NBC_MEM] (*) (*) (*) (*) (*) Other [NBC_OTH] 14.8 11.0 19.7 27 82


NBW (n=269) Didn't mind getting pregnant [NBC_MIND] 49.9 43.9 55.8 140 4101

Thought couldn't get pregnant at time [NBC_TIME] 10.4 7.3 14.5 29 855

Had side effects [NBC_SIDE] 14.9 11.1 19.8 38 1232 Had problems getting birth control [NBC_GET] 5.2 3.1 8.8 13 433

Thought sterile [NBC_STER] 7.6 4.9 11.5 19 626 Husband/partner didn’t want to use [NBC_HUSB] 10.9 7.6 15.5 27 903

Forgot to use [NBC_MEM] 4.6 2.7 7.8 13 382 Other [NBC_OTH] 14.9 11.0 19.8 38 1229

17. What method of birth control were you using when you got pregnant? **Women who answered No to Q15 were instructed to skip this question. Percent 95% CI Yes Population


The pill [PBC_PILL] 25.6 19.6 32.8 30 85 Condoms [PBC_COND] 34.1 27.2 41.7 39 113

Injection (Depo-Provera) [PBC_SHT3] (*) (*) (*) (*) (*) Implant (Implanon) [PBC_IMPL] (*) (*) (*) (*) (*)

Patch (OrthoEvra) or vaginal ring (NuvaRing) [PBC_PTRG]

(*) (*) (*) (*) (*)

IUD [PBC_IUD] (*) (*) (*) (*) (*) Natural family planning [PBC_RHYT] (*) (*) (*) (*) (*)

Withdrawal [PBC_PULL] 33.4 26.5 41.0 37 111 Other [PBC_OTH] (*) (*) (*) (*) (*)


NBW (n=219) The pill [PBC_PILL] 32.7 26.9 39.2 71 2252

Condoms [PBC_COND] 35.9 29.8 42.5 76 2472 Injection (Depo-Provera) [PBC_SHT3] (*) (*) (*) (*) (*)

Implant (Implanon) [PBC_IMPL] 0 0 0 0 0 Patch (OrthoEvra) or vaginal ring

(NuvaRing) [PBC_PTRG] (*) (*) (*) (*) (*)

IUD [PBC_IUD] (*) (*) (*) (*) (*) Natural family planning [PBC_RHYT] 8.8 5.9 13.0 22 608

Withdrawal [PBC_PULL] 34.2 28.2 40.7 74 2352 Other [PBC_OTH] (*) (*) (*) (*) (*)

During Pregnancy 18. How many week or months pregnant were you when you had your first visit for prenatal care? Do not count a visit that was only for a pregnancy test or only for WIC (the Special Supplemental Nutrition Program for Women Infants, and Children). Percent 95% CI Yes Population [PNC_1TRM] Yes Lower Upper Responses Estimate LBW (n=716)

PNC began in 1st trimester 88.9 86.7 90.7 641 1814 PNC began later than 1st trimester 10.1 8.3 12.1 68 206

No PNC (*) (*) (*) (*) (*) NBW (n=1141)

PNC began in 1st trimester 90.0 88.1 91.7 1033 30293 PNC began later than 1st trimester 9.2 7.6 11.0 99 3084

No PNC (*) (*) (*) (*) (*) NB: Because of question wording, both “13 weeks” and “3 months” are classified as not first trimester pregnancy. Kotelchuck index of prenatal care Adequacy of Prenatal Care Utilization (APNCU) index Percent 95% CI Yes Population [KOTELCHUCK] Yes Lower Upper Responses Estimate LBW (n=713) Inadequate 7.7 6.2 9.5 55 156 Intermediate 4.3 3.2 5.9 28 88 Adequate 19.3 17.0 21.8 136 392 Adequate plus 68.7 65.8 71.5 494 1399

2013 adequate plus (LBW=236) 71.5 66.5 76.0 169 448 2014 adequate plus (LBW=245) 66.4 61.2 71.1 166 467 2015 adequate plus (LBW=232) 68.6 63.3 73.4 159 483


NBW (n=1149) Inadequate 7.5 6.1 9.3 81 2554 Intermediate 6.2 5.0 7.8 73 2116 Adequate 47.5 44.6 50.4 552 16119 Adequate plus 38.7 36.0 41.6 443 13152

2013 adequate plus (NBW=388) 44.9 40.0 49.9 173 5057 2014 adequate plus (NBW=378) 37.4 32.6 42.3 141 4203 2015 adequate plus (NBW=383) 34.0 29.5 38.9 129 3892

19. Did you get prenatal care as early in your pregnancy as you wanted? Prenatal care as early as wanted Percent 95% CI Yes Population [ERLY6PNC] Yes Lower Upper Responses Estimate LBW (n=710) 83.8 81.4 85.9 596 1693 NBW (n=1137) 88.6 86.6 90.4 1016 29727 Number of visits for prenatal care Percent 95% CI Yes Population [PNC_VST_NAPHSIS] Yes Lower Upper Responses Estimate LBW (n=715) 8 or fewer visits 30.0 27.2 32.9 210 611 9 – 11 visits 30.5 27.7 33.4 219 622

2013 9-11 visits (LBW=237) 32.6 27.9 37.7 78 205 2014 9-11 visits (LBW=246) 29.9 25.4 34.9 74 211 2015 9-11 visits (LBW=232) 29.1 24.4 34.4 67 205

12 or more visits 39.6 36.6 42.6 286 808 NBW (n=1149) 8 or fewer visits 6.4 5.1 8.0 72 2185 9 – 11 visits 23.2 20.9 25.7 268 7885

2013 9-11 visits (NBW=388) 17.8 14.3 21.9 70 1998 2014 9-11 visits (NBW=378) 27.0 22.8 31.7 102 3037 2015 9-11 visits (NBW=383) 24.9 20.9 29.5 96 2849

12 or more visits 70.3 67.6 72.9 809 23871


20. Did any of these things keep you from getting prenatal care when you wanted it? **Women who answered Yes to Q19 were instructed to skip this question. Percent 95% CI Yes Population Yes Lower Upper Responses Estimate LBW (n=101)

Couldn’t get appointment [EP6APPT] 32.7 25.5 40.7 34 96 No money or insurance [EP6MONY] 22.6 16.5 30.3 22 64

No transportation [EP6TRAN] 18.5 12.6 26.3 16 53 Provider or health plan would not start as

early as I wanted [EP6START] 19.3 13.7 26.3 21 54

Too busy [EP6BUSY] 15.9 10.5 23.3 14 44 No leave time at work or school [EP6LEAVE] (*) (*) (*) (*) (*)

No Medicaid card [EP6MEDI] 12.9 8.2 19.8 12 36 No child care [EP6CHLD] (*) (*) (*) (*) (*)

Didn’t know was pregnant [EP6PREG] 53.1 45.0 61.0 50 155 Didn’t want anyone to know about

pregnancy [EP6SECRT] (*) (*) (*) (*) (*)

Didn’t want prenatal care [EP6PNC] 0 0 0 0 0 Couldn’t find provider who took Medicaid

or my insurance [EP6PRVDR] (*) (*) (*) (*) (*)

NBW (n=124) Couldn’t get appointment [EP6APPT] 28.1 21.0 36.6 36 1089

No money or insurance [EP6MONY] 22.1 15.7 30.1 28 858 No transportation [EP6TRAN] 9.6 5.4 16.5 11 363

Provider or health plan would not start as early as I wanted [EP6START] 23.3 16.8 31.5 30 894

Too busy [EP6BUSY] 15.8 10.2 23.6 18 602 No leave time at work or school [EP6LEAVE] 9.7 5.4 16.6 11 359

No Medicaid card [EP6MEDI] 20.9 14.6 29.0 25 802 No child care [EP6CHLD] (*) (*) (*) (*) (*)


Didn’t know was pregnant [EP6PREG] 38.6 30.6 47.4 48 1560 Didn’t want anyone to know about

pregnancy [EP6SECRT] 13.2 8.0 21.0 14 498

Didn’t want prenatal care [EP6PNC] (*) (*) (*) (*) (*) Couldn’t find provider who took Medicaid

or my insurance [EP6PRVDR] (*) (*) (*) (*) (*)

21. During your most recent pregnancy, what kind of health insurance did you have to pay for your prenatal care? **Women who did not get prenatal care were instructed to skip this question. Percent 95% CI Yes Population


Insurance paid by job [PP_WORK] 58.4 55.3 61.4 438 1194 Private, purchased insurance [PP_COMP] 1.5 1.0 2.4 12 31

Medicaid [PP_MEDIC] 38.6 35.6 41.7 259 789 Community health center or local hospital

program [PP_GOV] (*) (*) (*) (*) (*)

TRICARE or other military health [PP_MILIT] 1.8 1.1 2.9 12 36 Some other insurance [PP_OTH] 3.9 2.9 5.3 27 80

Did not have insurance [PP_NONE] 2.4 1.6 3.5 16 48 NBW (n=1152)

Insurance paid by job [PP_WORK] 65.6 62.8 68.4 783 22320 Private, purchased insurance [PP_COMP] 2.5 1.7 3.5 30 844

Medicaid [PP_MEDIC] 30.7 28.0 33.5 323 10444 Community health center or local hospital

program [PP_GOV] (*) (*) (*) (*) (*)

TRICARE or other military health [PP_MILIT] 1.6 1.0 2.4 19 53 Some other insurance [PP_OTH] 3.2 2.3 4.4 35 1082

Did not have insurance [PP_NONE] 1.6 1.0 2.5 19 554


22. During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? Please count only discussions, not reading materials or videos. **Women who did not get prenatal care were instructed to skip this question. Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=710) How much weight to gain [TLK_WT] 81.8 79.3 84.1 583 1654 Smoking [TLK_SMK] 77.1 74.5 79.6 541 1557 Breastfeeding [TLK_BF] 86.7 84.5 88.7 615 1754 Effects of drinking alcohol on baby [TLK_DRK] 75.7 73.0 78.3 538 1528 Seat belt use [TLK_BELT] 57.8 54.8 60.8 411 1162 Medicines that are safe to take [TLK_MEDS] 89.5 87.4 91.3 637 1809 Effects of illegal drugs on baby [TLK_DRUG] 68.0 65.1 70.8 476 1370 Testing for birth defects [TLK_BDEF] 91.9 90.1 93.5 654 1859 Signs of preterm labor [TLK_PRET] 75.7 73.0 78.3 534 1527 HIV testing [TLK_HIVT] 67.4 64.5 70.2 473 1360

2013 HIV testing (LBW=240) 70.9 66.0 75.4 169 451 2014 HIV testing (LBW=241) 63.1 57.9 67.9 149 435 2015 HIV testing (LBW=227) 68.6 63.3 73.5 155 474

Depression [TLK_DPRS] 78.7 76.1 81.1 562 1591 Physical abuse by husband or partner [TLK_ABUS] 56.6 53.5 59.6 394 1140

NBW (n=1138) How much weight to gain [TLK_WT] 81.6 79.3 83.8 928 27403 Smoking [TLK_SMK] 71.0 68.3 73.5 793 23797 Breastfeeding [TLK_BF] 89.8 87.9 91.4 1016 30046 Effects of drinking alcohol on baby [TLK_DRK] 72.3 69.7 74.8 810 24185 Seat belt use [TLK_BELT] 57.4 54.5 60.2 646 19145 Medicines that are safe to take [TLK_MEDS] 92.0 90.3 93.4 1041 30796 Effects of illegal drugs on baby [TLK_DRUG] 60.2 57.3 63.0 670 20113 Testing for birth defects [TLK_BDEF] 94.7 93.2 95.9 1079 31740


Signs of preterm labor [TLK_PRET] 81.9 79.5 84.0 932 27464 HIV testing [TLK_HIVT] 64.2 61.4 67.0 721 21444

2013 HIV testing (NBW=386) 71.0 66.3 75.3 270 7963 2014 HIV testing (NBW=370) 61.7 56.7 66.5 229 6792 2015 HIV testing (NBW=375) 59.9 54.9 64.7 222 6689

Depression [TLK_DPRS] 82.1 79.7 84.2 933 27476 Physical abuse by husband or partner [TLK_ABUS] 56.1 53.2 59.0 631 18709


23. At any time during your most recent pregnancy or delivery, did you have a test for HIV (the virus that causes AIDS)? Had HIV test during pregnancy Percent 95% CI Yes Population [HIVTEST_DK] Yes Lower Upper Responses Estimate LBW (n=709) 55.6 52.5 58.6 391 1124 NBW (n=1139) 51.7 48.8 54.6 583 17384 24. During the 12 months before the delivery of your new baby, did a doctor, nurse, or other health care worker offer you a flu shot or tell you to get one? Health care worker advised flu vaccine Percent 95% CI Yes Population [FLUSHOT] Yes Lower Upper Responses Estimate LBW (n=719) 87.2 85.0 89.2 630 1789 NBW (n=1151) 88.7 86.7 90.4 1025 30102 25. During the 12 months before the delivery of your new baby, did you get a flu shot? Percent 95% CI Yes Population [calculated from FLUPREG] Yes Lower Upper Responses Estimate LBW (n=713)

No flu shot 35.0 32.1 38.0 244 710 Yes, before pregnancy 15.2 13.1 17.6 107 309 Yes, during pregnancy 49.8 46.7 52.9 362 1012

NBW (n=1149) No flu shot 34.4 31.7 37.2 387 11660

Yes, before pregnancy 11.5 9.8 13.4 136 3899 Yes, during pregnancy 54.1 51.2 57.0 626 18338


26. Year and month of flu shot (used to calculate trimester of flu shot) Percent 95% CI Yes Population [FLUTRIM] Yes Lower Upper Responses Estimate LBW (n=232)

First trimester 28.3 23.7 33.3 67 181 Second trimester 44.3 39.1 49.7 103 284

Third trimester 27.4 22.9 32.5 62 176 NBW (n=409)

First trimester 30.1 25.9 34.6 126 3576 Second trimester 30.7 26.4 35.4 125 3653

Third trimester 39.2 34.6 44.0 158 4664 27. This question is about the care of your teeth during your most recent pregnancy. Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=717) Knew it was important to care for teeth/gums [DDS_CARE] 90.4 88.4 92.1 653 1849

Talk about how to care for teeth/gums [DDS_TALK] 50.4 47.3 53.4 373 1026

2013 talk how to care (LBW=240) 55.7 50.5 60.8 134 353 2014 talk how to care (LBW=243) 51.7 46.5 56.9 129 361 2015 talk how to care (LBW=231) 44.2 38.9 49.6 110 311

Had teeth cleaned during pregnancy [DDS_CLN] 44.2 41.2 47.2 329 899

Had insurance for dental care during pregnancy [DDS_INS] 63.5 60.5 66.5 466 1291

Needed dental care for a problem [DDS_PROB] 20.9 18.4 23.6 140 420 Received dental care for a problem [DDSWENT] 12.7 10.8 14.9 88 257 NBW (n=1154) Knew it was important to care for teeth/gums [DDS_CARE] 92.8 91.0 94.2 1077 31596

Talk about how to care for teeth/gums [DDS_TALK] 55.6 52.8 58.5 649 18837

2013 talk how to care (NBW=391) 59.3 54.3 64.1 234 6726 2014 talk how to care (NBW=378) 55.7 50.6 60.6 214 6261 2015 talk how to care (NBW=378) 51.9 46.9 56.9 201 5850

Had teeth cleaned during pregnancy [DDS_CLN] 55.5 52.6 58.3 655 18777

Had insurance for dental care during pregnancy [DDS_INS] 68.7 65.9 71.4 796 23099

Needed dental care for a problem [DDS_PROB] 19.2 17.0 21.7 205 6447 Received dental care for a problem [DDSWENT] 13.3 11.5 15.5 146 4478


28. During your most recent pregnancy, did you take a class or classes to prepare for childbirth and learn what to expect during labor and delivery? Childbirth classes to prepare for birth Percent 95% CI Yes Population [PGS_BIRT] Yes Lower Upper Responses Estimate LBW (n=716) 3-yr combined 20.9 18.6 23.4 162 426

LBW in 2013 (n=240) 25.2 21.0 30.0 61 160 LBW in 2014 (n=245) 21.2 17.3 25.6 55 149 LBW in 2015 (n=231) 16.7 13.2 20.8 46 117

NBW (n=1153) 3-yr combined 25.6 23.2 28.2 299 8706 NBW in 2013 (n=394) 27.7 23.5 32.4 109 3167 NBW in 2014 (n=378) 26.4 22.3 31.0 102 2973 NBW in 2015 (n=381) 22.6 18.7 27.0 88 2567

29. During your most recent pregnancy, did a home visitor come to your home to help you prepare for your new baby? A home visitor is a nurse, a health care worker, a social worker, or other person who works for a program that helps pregnant women. Home visitor to prepare for baby Percent 95% CI Yes Population [VST_PREP] Yes Lower Upper Responses Estimate LBW (n=716) 5.5 4.3 7.1 40 113 NBW (n=1152) 3.9 2.9 5.2 41 1310 30. During your most recent pregnancy, were you on WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children)? WIC during pregnancy Percent 95% CI Population [WIC_PREG] Yes Lower Upper Responses Estimate LBW (n=715) 34.9 32.0 37.9 234 712 NBW (n=1153) 27.2 24.7 30.0 287 9268


31. During your most recent pregnancy, were you told by a doctor, nurse, or other health care worker that you had gestational diabetes (diabetes that started during this pregnancy)? Gestational diabetes – this pregnancy Percent 95% CI Yes Population [PG_GDB] Yes Lower Upper Responses Estimate LBW (n=715) 11.0 9.3 13.1 79 225 NBW (n=1152) 7.7 6.3 9.4 87 2626

32. Have you smoked any cigarettes in the past 2 years? Smoked any cigarettes in the last 2 years Percent 95% CI Yes Population [SMK2YRS] Yes Lower Upper Responses Estimate LBW (n=714) 37.4 34.4 40.5 251 762 NBW (n=1149) 25.5 23.1 28.2 272 8657


33. In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day? **Women who answered No to Q32 were instructed to skip this question. Did smoke in the 3 months before pregnancy Percent 95% CI Yes Population [calculated from SMK6_3B] Yes Lower Upper Responses Estimate LBW (n=250) 90.6 87.2 93.2 225 688 NBW (n=272) 89.8 85.7 92.8 243 7773 Among all women (not just women who smoke): In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day? Did smoke in the 3 months before pregnancy Percent 95% CI Yes Population [SMK63B_A] Yes Lower Upper Responses Estimate LBW (n=713) 33.8 30.9 36.8 225 688 NBW (n=1149) 22.9 20.5 25.5 243 7773


34. In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? **Women who answered No to Q32 were instructed to skip this question. Did smoke in the last trimester Percent 95% CI Yes Population [calculated from SMK6_3L] Yes Lower Upper Responses Estimate LBW (n=250) 62.1 57 67.0 152 472 NBW (n=272) 40.2 34.5 46.2 105 3484 Among all women (not just women who smoke): In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? Did smoke in the last trimester Percent 95% CI Yes Population [SMK63L_A] Yes Lower Upper Responses Estimate LBW (n=713) 23.2 20.6 26.0 152 472 NBW (n=1149) 10.3 8.6 12.3 105 3484

35. How many cigarettes do you smoke on an average day now? **Women who answered No to Q32 were instructed to skip this question. Do smoke now (at time of survey) Percent 95% CI Yes Population [calculated from SMK6_3N] Yes Lower Upper Responses Estimate LBW (n=250) 72.7 67.8 77.0 180 552 NBW (n=272) 53.5 47.6 59.4 142 4632 Among all women (not just women who smoke): How many cigarettes do you smoke on an average day now? Do smoke now (at time of survey) Percent 95% CI Yes Population [SMK6NW_A] Yes Lower Upper Responses Estimate LBW (n=713) 27.1 24.4 30.0 180 552 NBW (n=1149) 13.7 11.7 15.9 142 4632


36. Have you had any alcoholic drinks in the past 2 years? Drank alcohol in the last 2 years Percent 95% CI Yes Population [DRK_2YRS] Yes Lower Upper Responses Estimate LBW (n=717) 78.9 76.3 81.4 572 1616 NBW (n=1153) 80.5 78.0 82.7 934 27372 37. During the 3 months before you got pregnant, how many alcoholic drinks did you have in an average week? **Women who answered No to Q36 were instructed to skip this question. Drank alcohol 3 months before pregnancy Percent 95% CI Yes Population [calculated from DRK6_3B] Yes Lower Upper Responses Estimate LBW (n=571) 84.4 81.7 86.7 483 1361 NBW (n=929) 89.2 87.1 91.1 829 24291 Among all women (not just women who drink): During the 3 months before you got pregnant, how many alcoholic drinks did you have in an average week? Drank alcohol 3 months before pregnancy Percent 95% CI Yes Population [DRK63B_A] Yes Lower Upper Responses Estimate LBW (n=716) 66.6 63.6 69.4 483 1361 NBW (n=1148) 71.7 69.0 74.2 829 24291


38. During the last 3 months of your pregnancy, how many alcoholic drinks did you have in an average week? **Women who answered No to Q36 were instructed to skip this question. Drank alcohol in last trimester Percent 95% CI Yes Population [calculated from DRK6_3L] Yes Lower Upper Responses Estimate LBW (n=571) 8.6 7.0 10.7 53 139 NBW (n=931) 14.3 12.2 16.7 135 3895 Among all women (not just women who drink): During the last 3 months of your pregnancy, how many alcoholic drinks did you have in an average week? Drank alcohol in last trimester Percent 95% CI Yes Population [DRK63L_A] Yes Lower Upper Responses Estimate LBW (n=716) 6.8 5.5 8.4 53 139 NBW (n=1150) 11.5 9.8 13.4 135 3895


39. This question is about things that may have happened during the 12 months before your new baby was born. Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=714) Family member was ill [STRS_FM3] 30.3 27.6 33.2 218 618 Divorce or separation [STRS_DV3] 7.8 6.3 9.6 53 158 Moved [STRS_MOV] 37.1 34.2 40.1 258 755 Homeless [STRSHOME] 4.8 3.6 6.3 31 97 Husband/partner lost job [STRS_JOB] 13.6 11.6 15.9 93 277 Mom (self) lost job [STRS_WRK] 9.3 7.6 11.3 62 190 Husband/partner or herself had cut in work hours or pay [STRS_PAY] 18.9 16.6 21.4 135 383

Apart from husband/partner for military deployment or extended work travel [STRS_AWY]

6.4 5.1 8.1 45 130

Frequent arguments [STRS_ARG] 23.5 20.9 26.2 161 478 Husband/partner did not want pregnancy [STRS_PG] 7.8 6.3 9.7 53 159

Couldn’t pay bills [STRS_BIL] 27.9 25.2 30.8 194 568 Husband/partner or herself in jail [STRS_JL3] 4.1 3.0 5.6 26 83 Others drinking or drugs [STRS_DRG] 20.1 17.7 22.8 134 410 Someone close died [STRS_DH3] 18.4 16.2 20.9 129 376

2013 someone died (LBW=240) 12.9 9.8 16.8 30 82 2014 someone died (LBW=247) 21.2 17.3 25.7 52 150 2015 someone died (LBW=228) 20.7 16.6 25.5 47 144

NBW (n=1152) Family member was ill [STRS_FM3] 27.5 25.0 30.2 317 9355 Divorce or separation [STRS_DV3] 4.9 3.8 6.4 51 1664 Moved [STRS_MOV] 36.6 33.8 39.4 409 12419 Homeless [STRSHOME] 1.8 1.2 2.8 19 617 Husband/partner lost job [STRS_JOB] 12.0 10.2 14.1 130 4078 Mom (self) lost job [STRS_WRK] 7.7 6.3 9.5 83 2621 Husband/partner or herself had cut in work hours or pay [STRS_PAY] 19.0 16.8 21.4 210 6439

Apart from husband/partner for military deployment or extended work travel [STRS_AWY]

4.1 3.1 5.3 47 1370

Frequent arguments [STRS_ARG] 20.5 18.2 23.0 222 6919 Husband/partner did not want pregnancy [STRS_PG] 7.3 5.9 9.1 75 2468

Couldn’t pay bills [STRS_BIL] 22.8 20.4 25.4 248 7731 Husband/partner or herself in jail [STRS_JL3] 2.2 1.5 3.3 24 748 Others drinking or drugs [STRS_DRG] 15.4 13.4 17.7 166 5225 Someone close died [STRS_DH3] 18.6 16.4 21.0 209 6297

2013 someone died (NBW=391) 19.2 15.5 23.6 71 2176 2014 someone died (NBW=377) 19.3 15.7 23.6 74 2169 2015 someone died (NBW=380) 17.3 13.8 21.4 64 1952


Number of stressors experienced during pregnancy (calculated from Q39 above) Percent 95% CI Yes Population [STRS_T_G] Yes Lower Upper Responses Estimate LBW (n=718)

No stressors 24.2 21.7 26.8 180 495 1 – 2 stressors 37.9 34.9 40.9 272 776 3 – 5 stressors 29.2 26.5 32.1 208 599

6 or more stressors 8.8 7.1 10.7 58 180 NBW (n=1152)

No stressors 27.7 25.2 30.3 331 9403 1 – 2 stressors 39.9 37.1 42.7 467 13551 3 – 5 stressors 26.5 24.0 29.2 292 9024

6 or more stressors 5.9 4.6 7.5 62 2014 40. During the 12 months before you got pregnant with your new baby, did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any way? Abuse by husband/partner 12 months before this pregnancy Percent 95% CI Yes Population [PAB6HUS] Yes Lower Upper Responses Estimate LBW (n=714) 3.9 2.9 5.4 26 80 NBW (n=1149) 2.1 1.3 3.1 21 694

41. During your most recent pregnancy, did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any way? Abuse by husband/partner during this pregnancy Percent 95% CI Yes Population [PAD6HUS] Yes Lower Upper Responses Estimate LBW (n=713) 3.8 2.8 5.3 25 78 NBW (n=1152) 1.2 0.7 2.0 13 404


Estimated gestational age, grouped into four categories Percent 95% CI Yes Population [GEST_WK_NAPHSIS] Yes Lower Upper Responses Estimate LBW (n=723)

<= 27 weeks 5.1 3.9 6.6 37 105 28 – 33 weeks 26.8 24.2 29.6 190 553 34 – 36 weeks 37.4 34.5 40.4 273 771 37 – 42 weeks 30.6 27.9 33.5 222 631

43+ weeks (*) (*) (*) (*) (*) NBW (n=1147)

<= 27 weeks 0 0 0 0 0 28 – 33 weeks (*) (*) (*) (*) (*) 34 – 36 weeks 2.8 2.0 3.9 34 956 37 – 42 weeks 97.0 95.9 97.8 1111 32878

43+ weeks (*) (*) (*) (*) (*) 43. Did your doctor, nurse, or other health care worker try to induce your labor (start your contractions using medicine)? Tried to induce labor Percent 95% CI Yes Population [INDUCE] Yes Lower Upper Responses Estimate LBW (n=712) 40.6 37.6 43.7 289 824 NBW (n=1152) 39.0 36.2 41.8 442 13262


44. Why did your doctor, nurse, or other health care worker try to induce your labor (start your contractions using medicine. **Only women who answered Yes to Q43 were instructed to answer this question. Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=294) Water broke, fear of infection [IND_INF] 22.8 19.1 27.0 69 192 Past due date [IND_DUE] (*) (*) (*) (*) (*)

2013 past due date (LBW=96) (*) (*) (*) (*) (*) 2014 past due date (LBW=103) (*) (*) (*) (*) (*)

2015 past due date (LBW=95) 0 0 0 0 0 Concerns about baby size [IND_SIZE] 23.8 19.9 28.1 69 199 Baby not doing well [IND_BBY] 13.7 10.7 17.4 39 115 Pregnancy complication [IND_COMP] 45.4 40.7 50.2 134 381 Labor stopped/not progressing [IND_LABR] 13.6 10.7 17.3 40 115 Wanted to schedule delivery [IND_PLAN] (*) (*) (*) (*) (*) To have a specific provider [IND_DOC] (*) (*) (*) (*) (*) Other reason [IND_OTH] 20.4 16.9 24.5 62 171 NBW (n=445) Water broke, fear of infection [IND_INF] 15.2 12.2 18.7 71 2024 Past due date [IND_DUE] 35.2 30.9 39.7 157 4699

2013 past due date (NBW=162) 25.8 19.8 33.0 44 1229 2014 past due date (NBW=155) 38.5 31.2 46.4 58 1813 2015 past due date (NBW=128) 42.7 34.4 51.4 55 1658

Concerns about baby size [IND_SIZE] 11.4 8.7 14.7 49 1516 Baby not doing well [IND_BBY] (*) (*) (*) (*) (*) Pregnancy complication [IND_COMP] 16.8 13.6 20.6 75 2241 Labor stopped/not progressing [IND_LABR] 20.5 17.0 24.5 92 2732 Wanted to schedule delivery [IND_PLAN] 5.0 3.2 7.6 20 662 To have a specific provider [IND_DOC] 3.1 1.8 5.3 13 416 Other reason [IND_OTH] 21.6 18.0 25.6 95 2871


45. By the end of your most recent pregnancy, how much weight had you gained? Percent 95% CI Yes Population [PGWT_GNU_DK] Yes Lower Upper Responses Estimate LBW (n=720)

Gained weight 88.8 86.7 90.6 642 1824 Lost weight 4.9 3.8 6.4 36 102

Weight didn’t change 1.4 0.9 2.3 10 29 Don’t know 4.8 3.6 6.4 32 99

NBW (n=1150) Gained weight 93.1 91.5 94.5 1073 31618

Lost weight 3.4 2.5 4.6 38 1158 Weight didn’t change (*) (*) (*) (*) (*)

Don’t know 2.6 1.8 3.7 29 882

After Pregnancy 46. After your baby was delivered, was he or she put in an intensive care unit (NICU)? Baby in NICU Percent 95% CI Yes Population [INF_ICU_DK] Yes Lower Upper Responses Estimate LBW (n=721) 57.1 54.1 60.1 406 1175 NBW (n=1158) 6.4 5.1 8.0 71 2190


47. After your baby was delivered, how long did he or she stay in the hospital? Percent 95% CI Yes Population [LTH_HOSP] Yes Lower Upper Responses Estimate LBW (n=720)

Less than 24 hours (less than 1 day) 1.9 1.2 2.8 14 38 24 to 48 hours (1 to 2 days) 14.4 12.4 16.7 104 297

3 to 5 days 28.2 25.5 31.0 207 578 6 to 14 days 18.5 16.2 20.9 134 379

More than 14 days 34.5 31.6 37.4 243 707 Baby was not born in a hospital (*) (*) (*) (*) (*)

Baby still in hospital (at time of survey) 2.3 1.5 3.4 16 46 NBW (n=1155)

Less than 24 hours (less than 1 day) (*) (*) (*) (*) (*) 24 to 48 hours (1 to 2 days) 61.2 58.3 63.9 708 20858

3 to 5 days 32.9 30.2 35.6 377 11201 6 to 14 days 2.7 1.9 3.9 32 935

More than 14 days 1.2 0.7 2.0 13 396 Baby was not born in a hospital 1.3 0.8 2.1 16 436

Baby still in hospital (at time of survey) 0 0 0 0 0 48. Is your baby alive now? **Women whose baby was still in the hospital were instructed to skip this question. Baby alive now Percent 95% CI Yes Population [INFLIVE5] Yes Lower Upper Responses Estimate LBW (n=695) 96.4 95.1 97.4 670 1908 NBW (n=1138) 100.0 x x 1138 33604


49. Is your baby living with you now? **Women who answered No to Q48 were instructed to skip this question. Baby living with mom Percent 95% CI Yes Population [INFWMOM5] Yes Lower Upper Responses Estimate LBW (n=672) 100.0 X X 672 1914 NBW (n=1134) 99.7 99.2 99.9 1134 33483 50. Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period of time? **Women who answered No to Q49 were instructed to skip this question. Breastfed – ever Percent 95% CI Yes Population [BF5EVER] Yes Lower Upper Responses Estimate LBW (n=693) 87.0 84.7 89.0 607 1718 NBW (n=1152) 89.3 87.3 91.0 1034 30372 51. Are you currently breastfeeding or feeding pumped milk to your baby? **Only women who answered Yes to Q50 were instructed to answer this question. Still Breastfeeding (at time of survey) Percent 95% CI Yes Population [BF5STILL] Yes Lower Upper Responses Estimate LBW (n=606) 56.2 52.8 59.4 349 963 NBW (n=1034) 64.5 61.5 67.3 682 19580 Currently breastfeeding, among all women **Based on all respondents with a live baby, not only Yes respondents to Q50. Still Breastfeeding (at time of survey) Percent 95% CI Yes Population [calculated from BF5STILL] Yes Lower Upper Responses Estimate LBW (n=724) 46.6 43.6 49.7 349 963 NBW (n=1161) 57.1 54.3 59.9 682 19580


52. How many weeks or months did you breastfeed or pump milk to feed your baby? **Only women who ever breastfed (Yes to Q50), but had stopped (No to Q51) were instructed to answer this question. Percent 95% CI Yes Population [calculated from BF5LNGTU and BF5LNGTH] Yes Lower Upper Responses Estimate LBW (n=607)

Less than 1 week 4.6 3.3 6.2 26 78 1 – 4 weeks or 1 month 15.5 13.2 18.1 88 266

5 – 8 weeks or 2 months 14.3 12.1 16.8 87 246 More than 8 weeks or 2 months 65.7 62.4 68.8 406 1128

NBW (n=1033) Less than 1 week 3.9 2.8 5.3 37 1178

1 – 4 weeks or 1 month 13.6 11.6 15.8 135 4114 5 – 8 weeks or 2 months 10.9 9.1 13.1 107 3321

More than 8 weeks or 2 months 71.6 68.7 74.3 754 21727 Duration of breastfeeding among all women Percent 95% CI Yes Population [calculated from BF5LNGTU and BF5LNGTH] Yes Lower Upper Responses Estimate LBW (n=693) Less than 1 week 4.0 2.9 5.4 26 78 1 – 4 weeks or 1 month 13.5 11.4 15.8 88 266 5 – 8 weeks or 2 months 12.4 10.5 14.6 87 246 More than 8 weeks or 2 months 57.1 54.0 60.2 406 1128

2013 more than 8wks (LBW=228) 53.5 48.1 58.7 122 323 2014 more than 8wks (LBW=236) 57.2 51.9 62.3 139 387 2015 more than 8wks (LBW=229) 60.3 54.7 65.6 145 418

Did not breastfeed 13.0 11.0 15.3 86 257 NBW (n=1151) Less than 1 week 3.5 2.5 4.7 37 1178 1 – 4 weeks or 1 month 12.1 10.3 14.1 135 4114 5 – 8 weeks or 2 months 9.8 8.1 11.7 107 3321 More than 8 weeks or 2 months 63.9 61.1 66.7 754 21727

2013 more than 8wks (NBW=392) 58.2 53.2 63.1 235 6620 2014 more than 8wks (NBW=376) 64.8 59.8 69.5 250 7247 2015 more than 8wks (NBW=383) 68.8 64.0 73.3 269 7860

Did not breastfeed 10.7 9.0 12.7 118 3638


53. What were your reasons for stopping breastfeeding? **Only women who answered No to Q51 were instructed to answer this question. Percent 95% CI Yes Population


Difficulty latching [BFC5DIFF] 31.4 26.9 36.2 86 241 Milk didn’t satisfy baby [BFC5SAT] 27.9 23.6 32.6 76 214

Baby not gaining weight [BFC5WT] 10.1 7.5 13.6 27 78 Nipples sore [BFC5SORE] 9.7 7.0 13.2 24 74

Too hard, painful, time-consuming [BFC6HARD] 21.7 17.9 26.1 59 167 Not producing enough milk [BFC5MILK] 55.9 50.8 60.9 147 430

Too many household duties [BFC5HOME] 14.0 10.8 17.9 36 107 Was right time to stop [BFC5STOP] 9.1 6.6 12.5 24 70

Got sick/medical reasons [BFC5ILLM] 5.6 3.8 8.3 16 43 Back to work/school [BFC5WORK] 13.9 10.7 17.7 38 107

Baby was jaundiced [BFC5JAUN] 5.8 3.9 8.6 16 45 Other [BFC5OTH] 29.8 25.4 34.7 78 229

NBW (n=358) Difficulty latching [BFC5DIFF] 33.2 28.6 38.2 120 3645

Milk didn’t satisfy baby [BFC5SAT] 43.5 38.5 48.7 158 4773 Baby not gaining weight [BFC5WT] 14.7 11.5 18.8 54 1616

Nipples sore [BFC5SORE] 29.7 25.2 34.7 104 3262 Too hard, painful, time-consuming [BFC6HARD] 26.7 22.3 31.5 95 2926

Not producing enough milk [BFC5MILK] 49.6 44.4 54.8 178 5443 Too many household duties [BFC5HOME] 11.7 8.7 15.6 41 1287

Was right time to stop [BFC5STOP] 6.5 4.4 9.4 25 708 Got sick/medical reasons [BFC5ILLM] 6.3 4.2 9.2 23 686

Back to work/school [BFC5WORK] 17.6 14.0 22.0 61 1936 Baby was jaundiced [BFC5JAUN] 6.1 4.1 9.1 23 674

Other [BFC5OTH] 26.2 21.8 31.0 92 2870


54. This question asks about things that may have happened at the hospital where your new baby was born. **Women whose baby had died or was not living with them, or whose baby was not born in a hospital, were instructed to skip this question. Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=595) Hospital staff gave breastfeeding info [BFH6INFO] 97.6 96.2 98.4 582 1645

Baby stayed in same hospital room with mom [BFH6ROOM] 52.2 48.9 55.6 316 878

Hospital staff helped me learn to breastfeed [BFH6HELP] 90.0 87.8 91.9 539 1518

2013 staff helped (LBW=183) 94.4 91.0 96.5 172 458 2014 staff helped (LBW=209) 90.3 86.4 93.1 189 534 2015 staff helped (LBW=203) 86.3 81.6 90.0 178 526

Breastfed in first hour after birth [BFH6HOUR] 42.0 38.7 45.3 247 701 Breastfed baby in hospital [BFH6BFED] 87.0 84.5 89.1 514 1448 Baby fed only breast milk at hospital [BFH6ONLY] 47.3 43.9 50.6 278 785 Hospital staff instructed to breastfeed on demand [BFH6WHEN] 65.0 61.7 68.1 384 1078

2013 on demand (LBW=180) 72.2 66.5 77.2 129 344 2014 on demand (LBW=205) 66.2 60.6 71.4 137 384 2015 on demand (LBW=201) 58.1 52.2 63.7 118 349

Hospital staff gave breast pump [BFH6PUMP] 88.8 86.5 90.7 526 1495 Hospital staff gave gift pack with formula [BFH6GIFT] 38.9 35.7 42.2 227 651

Hospital staff gave phone # for help with breastfeeding [BFH6FONE] 84.9 82.2 87.2 509 1421

Hospital staff gave baby a pacifier [BFH7PACI] 73.9 70.9 76.7 431 1239 2013 gave pacifier (LBW=182) 77.2 71.9 81.8 140 372 2014 gave pacifier (LBW=207) 74.0 69.0 78.5 149 433 2015 gave pacifier (LBW=203) 71.2 65.7 76.1 142 434


NBW (n=1008) Hospital staff gave breastfeeding info [BFH6INFO] 97.6 96.4 98.4 984 28895

Baby stayed in same hospital room with mom [BFH6ROOM] 97.0 95.7 97.9 978 28730

Hospital staff helped me learn to breastfeed [BFH6HELP] 89.2 87.1 90.9 897 26389

2013 staff helped (NBW=335) 85.9 81.7 89.3 289 8296 2014 staff helped (NBW=330) 91.7 88.2 94.2 302 8930 2015 staff helped (NBW=342) 89.9 86.3 92.6 306 9164

Breastfed in first hour after birth [BFH6HOUR] 85.0 82.6 87.0 857 25114 Breastfed baby in hospital [BFH6BFED] 97.5 96.3 98.3 978 28733 Baby fed only breast milk at hospital [BFH6ONLY] 79.2 76.6 81.7 803 23421 Hospital staff instructed to breastfeed on demand [BFH6WHEN] 92.5 90.6 94.0 931 27273

2013 on demand (NBW=335) 91.6 87.9 94.3 309 8846 2014 on demand (NBW=328) 92.4 88.9 94.8 304 8949 2015 on demand (NBW=340) 93.4 90.2 95.6 318 9477

Hospital staff gave breast pump [BFH6PUMP] 37.6 34.6 40.6 367 11116 Hospital staff gave gift pack with formula [BFH6GIFT] 20.3 17.9 22.9 198 5975

Hospital staff gave phone # for help with breastfeeding [BFH6FONE] 91.8 89.9 93.4 928 27121

Hospital staff gave baby a pacifier [BFH7PACI] 33.4 30.5 36.4 329 9819 2013 gave pacifier (NBW=334) 41.0 35.8 46.5 135 3951 2014 gave pacifier (NBW=329) 28.2 23.6 33.4 90 2741 2015 gave pacifier (NBW=338) 31.0 26.4 36.2 104 3127


55. Since your new baby was born, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? Please count only discussions, not reading materials or videos. **Women whose baby had died or was not living with them were instructed to skip this question. Percent 95% CI Yes Population


Help or information about breastfeeding [PP_BF] 88.5 86.3 90.5 610 1725

How long to wait before next pregnancy [PP_PREG] 54.3 51.2 57.5 374 1053

Birth control methods [PP_BC] 85.2 82.8 87.3 583 1654


Depression, baby-blues [PP_DEPRS] 91.4 89.5 93.0 622 1772 Support groups for new parents [PP_SUPRT] 60.9 57.8 63.9 415 1179

Community resources [PP_RES] 70.2 67.2 73.0 481 1356 Healthy weight after delivery [PP_WT] 36.2 33.2 39.3 245 701

What happens if a baby is shaken [PP_SHAKE] 71.1 68.1 73.8 484 1379 How to quiet a crying baby [PP_QUIET] 73.7 70.9 76.4 506 1433

2013 how to quiet (LBW=219) 80.1 75.4 84.1 175 464 2014 how to quiet (LBW=234) 69.8 64.7 74.4 164 467 2015 how to quiet (LBW=228) 72.3 67.1 77.0 167 502

If someone is hurting emotionally [PP_HURT] 50.6 47.4 53.7 341 979 NBW (n=1142)

Help or information about breastfeeding [PP_BF] 88.9 86.9 90.6 1017 29952

How long to wait before next pregnancy [PP_PREG] 53.8 50.9 56.7 612 18102

Birth control methods [PP_BC] 90.0 88.1 91.6 1026 30251 Depression, baby-blues [PP_DEPRS] 92.4 90.7 93.8 1053 31087

Support groups for new parents [PP_SUPRT] 63.2 60.3 65.9 721 21221 Community resources [PP_RES] 64.5 61.7 67.3 736 21652

Healthy weight after delivery [PP_WT] 38.1 35.3 40.9 437 12805 What happens if a baby is shaken [PP_SHAKE] 66.0 63.2 68.6 746 22107

How to quiet a crying baby [PP_QUIET] 72.7 70.1 75.2 825 24449 2013 how to quiet (NBW=389) 73.8 69.2 77.9 285 8328 2014 how to quiet (NBW=371) 68.1 63.2 72.6 250 7522 2015 how to quiet (NBW=379) 76.2 71.7 80.2 290 8599

If someone is hurting emotionally [PP_HURT] 45.8 43.0 48.7 520 15396


56. In which one position do you most often lay your baby down to sleep now? **Women whose baby had died, or was not living with them, or was still in the hospital, were instructed to skip this question. Correct position – On Back Percent 95% CI Yes Population [calculated from SLEEPPOS] Yes Lower Upper Responses Estimate LBW (n=674) 87.9 85.7 89.9 596 1691 NBW (n=1130) 88.4 86.4 90.1 999 29472 57. Since your new baby was born, has a home visitor come to your home to help you learn how to take care of yourself or your new baby? A home visitor is a nurse, a health care worker, a social worker, or other person who works for a program that helps mothers of newborns. **Women whose baby had died, or was not living with them, were instructed to skip this question. Home visitor to help care for self/baby Percent 95% CI Yes Population [VST_CARE] Yes Lower Upper Responses Estimate LBW (n=685) 50.7 47.6 53.8 349 991 NBW (n=1145) 31.0 28.4 33.7 357 10473


58. Are you or your husband or partner doing anything now to keep from getting pregnant? Postpartum birth control – using now Percent 95% CI Yes Population [BC_NOW4] Yes Lower Upper Responses Estimate LBW (n=717) 76.8 74.1 79.3 551 1568 NBW (n=1150) 82.7 80.5 84.8 947 28073


59. What are your reasons or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant now? **Women who answered Yes to Q58 were instructed to skip this question. Percent 95% CI Yes Population


Not having sex [BCB_NSEX] 31.2 25.8 37.2 55 155 Want to get pregnant [BCB_PREG] 12.0 8.7 16.3 23 59

Don’t want to use birth control [BCB_WANT] 21.7 17.0 27.2 38 108 Concern over side effects [BCB_SIDE] 17.7 13.4 22.9 31 88

Husband/partner doesn’t want to use any [BCB_HUSB] 5.8 3.5 9.6 10 29

Problems getting birth control [BCB_PROB] (*) (*) (*) (*) (*) Tubes tied/blocked [BCB_TUBE] 13.0 9.3 18.0 21 65

Vasectomy [BCB_VASE] (*) (*) (*) (*) (*) Pregnant now [BCB_PNOW] (*) (*) (*) (*) (*)

Other reason [BCB_OTH] 32.7 27.1 38.9 54 163 NBW (n=213)

Not having sex [BCB_NSEX] 34.1 28.0 40.8 70 2100 Want to get pregnant [BCB_PREG] 14.4 10.4 19.6 32 885

Don’t want to use birth control [BCB_WANT] 29.0 23.4 35.4 64 1786 Concern over side effects [BCB_SIDE] 18.9 14.2 24.7 40 1161

Husband/partner doesn’t want to use any [BCB_HUSB] 5.2 2.9 9.2 11 322

Problems getting birth control [BCB_PROB] (*) (*) (*) (*) (*) Tubes tied/blocked [BCB_TUBE] 8.9 5.8 13.5 19 546

Vasectomy [BCB_VASE] (*) (*) (*) (*) (*) Pregnant now [BCB_PNOW] (*) (*) (*) (*) (*)

Other reason [BCB_OTH] 19.9 15.2 25.8 43 1227


60. What kind of birth control are you or your husband or partner using now to keep from getting pregnant? **Only women who answered Yes to Q58 were instructed to answer this question. Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=558) Tubes tied/blocked [BCP_TUBE] 10.7 8.7 13.1 58 170 Vasectomy [BCP_VASE] 1.9 1.2 3.1 11 30 The pill [BCP_PILL] 26.1 23.2 29.3 148 416

2013 the pill (LBW=186) 33.8 28.5 39.6 63 166 2014 the pill (LBW=190) 22.1 17.5 27.5 41 120 2015 the pill (LBW=182) 23.2 18.5 28.8 44 129

Condoms [BCP_COND] 25.9 23.0 29.0 148 412 Injection (Depo-Provera) [BCP_SHT3] 6.6 5.0 8.7 34 105 Contraceptive implant (Implanon) [BCP_IMPL] 4.3 3.1 6.0 23 69 Contraceptive patch (OrthoEvra) or vaginal ring (NuvaRing) [BCP_PTRG]

(*) (*) (*) (*) (*)

IUD (including Mirena or ParaGard) [BCP_IUD]

18.4 15.9 21.3 102 293

Natural family planning [BCP_RHYT] 3.3 2.3 4.7 19 52 Withdrawal [BCP_PULL] 12.2 10.1 14.7 67 194 Not having sex [BCP_NSEX] 11.8 9.8 14.3 65 188 Other [BCP_OTH] 3.0 2.0 4.5 15 48 NBW (n=958) Tubes tied/blocked [BCP_TUBE] 6.7 5.2 8.4 64 1890 Vasectomy [BCP_VASE] 4.7 3.5 6.1 49 1323 The pill [BCP_PILL] 24.2 21.6 27.1 232 6888

2013 the pill (NBW=329) 22.8 18.6 27.7 75 2200 2014 the pill (NBW=313) 26.7 22.2 31.9 84 2484 2015 the pill (NBW=316) 23.3 18.9 28.2 73 2204

Condoms [BCP_COND] 30.6 27.7 33.5 295 8680 Injection (Depo-Provera) [BCP_SHT3] 4.2 3.0 5.7 36 1187 Contraceptive implant (Implanon) [BCP_IMPL] 4.9 3.7 6.6 44 1403 Contraceptive patch (OrthoEvra) or vaginal ring (NuvaRing) [BCP_PTRG]

2.0 1.2 3.1 18 559

IUD (including Mirena or ParaGard) [BCP_IUD] 22.3 19.8 25.1 210 6339

Natural family planning [BCP_RHYT] 2.9 2.0 4.1 29 822 Withdrawal [BCP_PULL] 13.7 11.7 16.1 131 3899 Not having sex [BCP_NSEX] 8.3 6.8 10.2 82 2368 Other [BCP_OTH] 2.7 1.8 3.9 26 757


61. Since your new baby was born, have you had a postpartum checkup for yourself? Postpartum checkup for herself Percent 95% CI Yes Population [PPV_CHK] Yes Lower Upper Responses Estimate LBW (n=719) 88.7 86.6 90.6 644 1819 NBW (n=1151) 93.2 91.5 94.5 1077 31643


62. Since your new baby was born, how often have you felt down, depressed, or hopeless? Percent 95% CI Yes Population [MH_PPDPR] Yes Lower Upper Responses Estimate LBW (n=722) Always 2.1 1.4 3.3 14 44 Often 10.8 9.0 12.8 75 222 Sometimes 25.3 22.7 28.0 186 520 Rarely 33.9 31.1 36.8 246 698

Rarely, in 2013 (LBW=242) 27.0 22.6 31.8 65 173 Rarely, in 2014 (LBW=247) 35.6 30.9 40.7 89 253 Rarely, in 2015 (LBW=233) 38.4 33.3 43.8 92 273

Never 28.0 25.3 30.8 201 576 NBW (n=1159) Always (*) (*) (*) (*) (*) Often 6.9 5.5 8.6 73 2348 Sometimes 21.9 19.6 24.4 250 7501 Rarely 38.8 36.1 41.6 455 13279

Rarely, in 2013 (NBW=396) 35.5 31.0 40.4 142 4081 Rarely, in 2014 (NBW=379) 40.7 35.9 45.7 157 4590 Rarely, in 2015 (NBW=384) 40.3 35.5 45.2 156 4609

Never 31.7 29.1 34.4 374 10852 63. Since your new baby was born, how often have you had little interest or little pleasure in doing things? Percent 95% CI Yes Population [MH_PPINT] Yes Lower Upper Responses Estimate LBW (n=722) Always 2.6 1.8 3.8 19 55 Often 9.6 7.9 11.6 66 197 Sometimes 22.5 20.0 25.1 161 462 Rarely 28.9 26.2 31.7 209 595

Rarely, in 2013 (LBW=242) 22.7 18.6 27.4 54 145 Rarely, in 2014 (LBW=248) 32.2 27.6 37.1 81 229 Rarely, in 2015 (LBW=232) 31.2 26.4 36.5 74 220

Never 36.4 33.6 39.4 267 751 NBW (n=1158) Always 1.5 0.9 2.4 16 507 Often 5.8 4.6 7.4 64 1993 Sometimes 18.7 16.6 21.1 208 6407 Rarely 33.3 30.6 36.1 390 11383

Rarely, in 2013 (NBW=396) 34.1 29.6 38.9 136 3914 Rarely, in 2014 (NBW=379) 32.7 28.2 37.6 125 3694 Rarely, in 2015 (NBW=383) 33.1 28.6 37.9 129 3774

Never 40.6 37.9 43.5 480 13897


Summary measure of postpartum depression (answered “Always” or “Often” to either Q62 or Q63) Percent 95% CI Yes Population [PP_DEPRESS] Yes Lower Upper Responses Estimate LBW (n=721) 18.8 16.5 21.4 130 387 NBW (n=1158) 11.0 9.3 13.0 120 3758

64. What kind of health insurance do you have now? Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=724) From job [HI_WORK] 56.0 53.0 59.1 425 1157 Purchased [HI_COMP] 2.0 1.4 3.0 16 42 Medicaid [HI_MEDIC] 29.2 26.5 32.2 193 604

Medicaid, in 2013 (LBW=243) 21.1 17.1 25.7 49 136 Medicaid, in 2014 (LBW=248) 30.6 26.0 35.6 72 218 Medicaid, in 2015 (LBW=233) 35.3 30.1 40.8 72 250

State-specific other govt. entity [HI_GOV] (*) (*) (*) (*) (*) TRICARE or military [HI_MILIT] 1.7 1.1 2.7 12 35 Other [HI_OTH] 4.3 3.2 5.7 30 89 No Insurance [HI_NONE] 11.2 9.4 13.3 79 232

No insurance, in 2013 (LBW=243) 15.0 11.7 19.1 37 97 No insurance, in 2014 (LBW=248) 12.5 9.4 16.4 29 89 No insurance, in 2015 (LBW=233) 6.5 4.1 10.0 13 46

NBW (n=1161) From job [HI_WORK] 63.1 60.2 65.9 761 21624 Purchased [HI_COMP] 2.1 1.4 3.0 26 716 Medicaid [HI_MEDIC] 21.7 19.4 24.3 227 7445

Medicaid, in 2013 (NBW=396) 15.3 11.9 19.5 54 1756 Medicaid, in 2014 (NBW=380) 22.8 18.8 27.4 80 2577 Medicaid, in 2015 (NBW=385) 27.1 22.8 31.9 93 3111

Postpartum depression was defined as ‘Yes’ if respondent answered ‘Always’ or ‘Often’ to either Q62 or Q63.


State-specific other govt. entity [HI_GOV] (*) (*) (*) (*) (*) TRICARE or military [HI_MILIT] 1.7 1.1 2.6 21 589 Other [HI_OTH] 3.7 2.7 5.0 39 1255 No Insurance [HI_NONE] 10.1 8.5 12.0 112 3478

No insurance, in 2013 (NBW=396) 17.6 14.1 21.8 66 2019 No insurance, in 2014 (NBW=380) 7.0 4.8 10.1 25 790 No insurance, in 2015 (NBW=385) 5.8 3.8 8.7 21 669

Other Experiences 65. During the 12 months before the delivery of your new baby, did you get your household tap water from a private water system, such as a well? Get house tap water from private system Percent 95% CI Yes Population [HS_WATER] Yes Lower Upper Responses Estimate LBW (n=714) 40.1 37.1 43.1 289 816 NBW (n=1150) 38.3 35.6 41.2 453 13019 66. During the 12 months before the delivery of your new baby, did your doctor, nurse, or other health care worker talk to you about getting your household tap water tested for arsenic? **Women who answered No to Q65 were instructed to skip this question. Health care worker advised to get house tap water tested for arsenic Percent 95% CI Yes Population [HS_WTRTST] Yes Lower Upper Responses Estimate LBW (n=288) 14.7 11.6 18.4 43 120 NBW (n=453) 14.5 11.5 18.1 65 1889


67. During the 12 months before the delivery of your new baby, did you have your well water tested for arsenic? **Women who answered No to Q65 were instructed to skip this question. Got well tested for arsenic Percent 95% CI Yes Population [WELLTST] Yes Lower Upper Responses Estimate LBW (n=286) 24.6 20.8 28.9 76 199 NBW (n=449) 28.9 25.0 33.2 134 3739 68. During any of your prenatal care visits, did a doctor, nurse, or health care worker-- **Women who did not smoke during the 3 months before they got pregnant or did not get prenatal care were instructed to skip this question. Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=206) Advise how to quit [SMKA_STP] 57.5 51.8 63.1 120 363 Advise setting a date to quit [SMKA_DAT] 34.0 28.9 39.5 72 215

Advise setting date, in 2013 (LBW=73) 43.5 34.4 52.9 31 86 Advise setting date, in 2014 (LBW=68) 39.1 30.0 48.9 26 84 Advise setting date, in 2015 (LBW=65) 20.6 13.7 29.6 15 45

Suggest attending a class [SMKA_CLS] 30.3 25.3 35.8 62 189 Provide booklets/videos [SMKA_BK] 42.8 37.2 48.5 88 269 Refer to counseling [SMKA_HLP] 15.8 12.2 20.3 34 99 Asked about family support [SMKA_FAM] 33.7 28.5 39.3 69 209 Refer to a quit line [SMKA_CAL] 22.7 18.4 27.7 49 142 Advise nicotine gum [SMKA_GUM] 19.8 15.6 24.7 41 124 Advise nicotine patch [SMKA_PAT] 23.8 19.3 29.1 48 149 Prescribe nicotine spray/inhaler [SMKA_SPY] (*) (*) (*) (*) (*) Prescribe a pill [SMKA_PIL] (*) (*) (*) (*) (*) NBW (n=211) Advise how to quit [SMKA_STP] 41.7 35.2 48.4 88 2807 Advise setting a date to quit [SMKA_DAT] 23.2 18.0 29.4 49 1548

Advise setting date, in 2013 (NBW=84) 24.7 16.7 35.0 21 638 Advise setting date, in 2014 (NBW=67) 27.0 17.8 38.7 18 571 Advise setting date, in 2015 (NBW=58) 17.2 9.6 29.0 10 339

Suggest attending a class [SMKA_CLS] 22.2 17.1 28.3 46 1492 Provide booklets/videos [SMKA_BK] 26.2 20.7 32.5 54 1742 Refer to counseling [SMKA_HLP] 13.3 9.3 18.7 27 887 Asked about family support [SMKA_FAM] 24.1 18.8 30.4 49 1593 Refer to a quit line [SMKA_CAL] 13.4 9.4 18.8 27 873 Advise nicotine gum [SMKA_GUM] 10.5 7.0 15.4 22 689 Advise nicotine patch [SMKA_PAT] 12.1 8.3 17.3 25 791 Prescribe nicotine spray/inhaler [SMKA_SPY] (*) (*) (*) (*) (*) Prescribe a pill [SMKA_PIL] (*) (*) (*) (*) (*)


69. Listed below are some statements about safety. For each one, check No if it does not apply to you or Yes if it does. **Women whose baby was not alive, not living with them, or was still in the hospital, were instructed to skip this question. Percent 95% CI Yes Population

Yes Lower Upper Responses Estimate LBW (n=674) I know baby CPR [SAF_BCPR] 68.7 65.7 71.5 466 1320

Know baby CPR, in 2013 (LBW=217) 77.6 72.6 81.8 169 445 Know baby CPR, in 2014 (LBW=231) 61.4 56.1 66.5 142 407 Know baby CPR, in 2015 (LBW=226) 68.3 62.9 73.2 155 468

Working smoke alarm at home [SAF_SMOK] 97.8 96.6 98.5 660 1881


Supplies out of reach of children [SAF_MTRL] 96.2 94.9 97.2 649 1855 Always use rear-facing infant care seat [SAF_RFST] 99.7 99.1 99.9 673 1919

Poison control # accessible in home [SAF_PSN] 76.9 74.2 79.4 511 1472 Carbon monoxide alarm in home [SAF_CMAL] 77.8 75.1 80.4 517 1476 Baby always supervised in/round water [SAF_BWTR] 98.9 98.1 99.4 667 1903

Loaded firearms in home [SFT_FRARM] 6.7 5.2 8.5 44 128 Always used seatbelt during pregnancy [SFT_STBLT] 78.9 76.1 81.4 540 1515

NBW (n=1134) I know baby CPR [SAF_BCPR] 62.6 59.8 65.4 714 20952

Know baby CPR, in 2013 (NBW=386) 66.4 61.5 71.0 257 7420 Know baby CPR, in 2014 (NBW=376) 58.8 53.8 63.7 223 6589 Know baby CPR, in 2015 (NBW=372) 62.7 57.7 67.5 234 6943

Working smoke alarm at home [SAF_SMOK] 98.2 97.1 98.8 1120 32960 Supplies out of reach of children [SAF_MTRL] 95.7 94.4 96.7 1088 32198 Always use rear-facing infant care seat [SAF_RFST] 99.1 98.3 99.5 1131 33384

Poison control # accessible in home [SAF_PSN] 72.0 69.3 74.5 814 24212 Carbon monoxide alarm in home [SAF_CMAL] 78.0 75.5 80.4 889 26027 Baby always supervised in/round water [SAF_BWTR] 99.4 98.7 99.8 1133 33407

Loaded firearms in home [SFT_FRARM] 8.4 6.9 10.1 97 2803 Always used seatbelt during pregnancy [SFT_STBLT] 85.8 83.6 87.8 989 28763


70. How often do you, other adults, or any other children sleep with your new baby in the same bed, couch, or chair. **Women whose baby was not alive, was not living with them, or was still in the hospital, were instructed to skip this question. Percent 95% CI Yes Population [SLPWBBY] Yes Lower Upper Responses Estimate LBW (n=677)

Always 4.5 3.3 6.0 30 87 Often 10.3 8.5 12.3 71 198

Sometimes 23.1 20.6 25.8 159 446 Rarely 26.1 23.4 28.9 176 504 Never 36.1 33.1 39.2 241 697

NBW (n=1142) Always 8.1 6.6 9.9 90 2735

Often 13.2 11.4 15.3 149 4462 Sometimes 17.2 15.1 19.4 197 5785

Rarely 30.5 27.9 33.2 349 10272 Never 31.0 28.4 33.8 357 10455


71. In the past 12 months, have you sent or received a text message on your cell phone? Percent 95% CI Yes Population [TXT_MESG] Yes Lower Upper Responses Estimate LBW (n=715)

Sent/received text on cell phone 94.4 92.7 95.7 678 1923 Did not send/receive text on cell phone 3.2 2.2 4.4 22 65

Does not have cell phone 2.5 1.6 3.7 15 50 NBW (n=1147)

Sent/received text on cell phone 95.2 93.8 96.3 1093 32213 Did not send/receive text on cell phone 3.1 2.2 4.2 35 1036

Does not have cell phone 1.7 1.1 2.7 19 590 72. Have you used any of the following sources to find information or assistance with pregnancy issues? Percent 95% CI Yes Population Yes Lower Upper Responses Estimate LBW (n=724) Internet search [INF_ITRNT] 92.0 90.2 93.5 668 1900 Text messages [INF_TEXT] 25.6 23.1 28.3 191 529 Email [INF_EMAIL] 26.6 24.1 29.4 204 550 Twitter [INF_TWITR] (*) (*) (*) (*) (*) Facebook [INF_FB] 37.3 34.4 40.2 272 769 Online bulletin board [INF_FORUM] 37.9 35.0 40.8 286 782 Face-to-face [INF_F2F] 78.5 75.9 81.0 577 1622 Magazine [INF_MAG] 32.3 29.5 35.2 238 666

Magazine, in 2013 (LBW=243) 38.3 33.4 43.5 93 246 Magazine, in 2014 (LBW=248) 30.6 26.0 35.5 75 218 Magazine, in 2015 (LBW=233) 28.5 23.9 33.6 70 202


Newspaper [INF_PAPER] 3.7 2.7 5.0 27 76 Book [INF_BOOK] 48.5 45.5 51.5 367 1001

Book, in 2013 (LBW=243) 56.5 51.3 61.5 138 363 Book, in 2014 (LBW=248) 47.6 42.5 52.7 122 339 Book, in 2015 (LBW=233) 42.1 36.9 47.5 107 299

Radio [INF_RADIO] 3.8 2.8 5.1 28 79 Video [INF_VIDEO] 20.0 17.7 22.5 149 413 Other sources [INF_OTH] 5.1 3.9 6.7 36 106 NBW (n=1160) Internet search [INF_ITRNT] 94.0 92.5 95.3 1093 32204 Text messages [INF_TEXT] 24.7 22.3 27.3 285 8458 Email [INF_EMAIL] 27.3 24.9 29.9 324 9358 Twitter [INF_TWITR] (*) (*) (*) (*) (*) Facebook [INF_FB] 36.0 33.3 38.8 414 12320 Online bulletin board [INF_FORUM] 41.8 39.0 44.6 493 14310 Face-to-face [INF_F2F] 81.6 79.2 83.7 950 28936 Magazine [INF_MAG] 36.0 33.4 38.8 419 12344

Magazine, in 2013 (NBW=396) 43.2 38.4 48.2 173 4966 Magazine, in 2014 (NBW=379) 38.0 33.3 43.0 143 4290 Magazine, in 2015 (NBW=385) 26.9 22.7 31.5 103 3089

Newspaper [INF_PAPER] 3.1 2.2 4.3 33 1059 Book [INF_BOOK] 50.8 47.9 53.6 594 17392

Book, in 2013 (NBW=396) 56.4 51.4 61.3 225 6478 Book, in 2014 (NBW=379) 53.7 48.6 58.6 205 6055 Book, in 2015 (NBW=385) 42.3 37.5 47.3 164 4860

Radio [INF_RADIO] 2.3 1.6 3.4 26 801 Video [INF_VIDEO] 16.5 14.5 18.7 190 5645 Other sources [INF_OTH] 3.5 2.5 4.7 40 1182


73. During the 12 months before your new baby was born, what was your yearly total household income before taxes? Include your income, your husband’s or partner’s income, and any other income you may have received. All information will be kept private and will not affect any services you are now getting. Total respondents: 615 Percent 95% CI Yes Population [INCOME7] Yes Lower Upper Responses Estimate LBW (n=691)

$0 to $15,000 19.5 17.1 22.1 126 384 $15,001 to $19,000 8.0 6.4 10.0 48 158 $19,001 to $22,000 4.1 3.0 5.5 27 80 $22,001 to $26,000 4.2 3.1 5.7 27 83 $26,001 to $29,000 3.4 2.5 4.7 25 67 $29,001 to $37,000 5.6 4.3 7.2 38 110 $37,001 to $44,000 4.8 3.6 6.3 33 95 $44,001 to $52,000 5.7 4.4 7.3 40 112 $52,001 to $56,000 3.2 2.2 4.5 21 63 $56,001 to $67,000 4.3 3.2 5.7 32 85 $67,001 to $79,000 6.5 5.2 8.2 47 129

$79,001 or more 30.8 28.0 33.7 227 607 NBW (n=1120)

$0 to $15,000 15.3 13.3 17.7 155 5057 $15,001 to $19,000 4.4 3.3 5.9 44 1463 $19,001 to $22,000 4.2 3.1 5.6 44 1379 $22,001 to $26,000 3.9 2.9 5.3 40 1294 $26,001 to $29,000 3.2 2.3 4.5 33 1056 $29,001 to $37,000 4.8 3.7 6.2 51 1578 $37,001 to $44,000 5.4 4.3 6.9 61 1796 $44,001 to $52,000 5.2 4.1 6.7 59 1728 $52,001 to $56,000 3.7 2.8 5.0 43 1230 $56,001 to $67,000 5.2 4.1 6.7 60 1723 $67,001 to $79,000 7.8 6.4 9.5 91 2566

$79,001 or more 36.7 34.0 39.5 439 12085 74. During the 12 months before your new baby was born, how many people, including yourself, depended on this income? Percent 95% CI Yes Population [calculated from INC_NDEP] Yes Lower Upper Responses Estimate LBW (n=703)

1 dependent 7.4 5.9 9.1 52 148 2 dependents 45.8 42.8 48.9 334 919 3 dependents 26.7 24.0 29.5 183 535 4 dependents 12.5 10.6 14.7 84 251 5 dependents 4.5 3.3 6.1 28 90 6 dependents 1.6 1.0 2.6 11 32

More than 6 dependents 1.6 1.0 2.5 11 31


NBW (n=1118) 1 dependent 5.9 4.6 7.6 60 1954

2 dependents 38.7 35.9 41.6 426 12764 3 dependents 32.6 30.0 35.4 378 10741 4 dependents 13.7 11.8 15.8 155 4496 5 dependents 5.7 4.4 7.2 62 1865 6 dependents 2.2 1.5 3.2 25 714

More than 6 dependents 1.2 0.7 2.2 12 406 Percent of Federal Poverty Level (FPL) Percent 95% CI Yes Population [calculated from INCOME7 and INC_NDEP] Yes Lower Upper Responses Estimate LBW (n=688)

0 - 185% of FPL 49.1 46.0 52.2 317 964 >185%+ of FPL 50.9 47.8 54.0 371 1000

NBW (n=1107) 0 - 185% of FPL 40.7 37.8 43.7 416 13253 >185%+ of FPL 59.3 56.3 62.2 691 19314

Demographics / Birth Certificate Variables Urban/Rural Percent 95% CI Yes Population [URB_RUR] Yes Lower Upper Responses Estimate LBW (n=724)

Urban 61.7 58.7 64.6 445 1274 Rural 38.3 35.4 41.3 279 791

NBW (n=1161) Urban 63.4 60.7 66.2 730 21746 Rural 36.6 33.8 39.3 431 12529


Married Percent 95% CI Yes Population [MARRIED] Yes Lower Upper Responses Estimate LBW (n=724) 60.5 57.4 63.4 450 1249 NBW (n=1160) 65.5 62.6 68.2 811 22402

Education Percent 95% CI Yes Population [calculated from MAT_ED] Yes Lower Upper Responses Estimate LBW (n=719)

Less than 12 years 11.6 9.7 13.9 71 238 12 years 23.0 20.4 25.8 141 471

More than 12 years 65.4 62.3 68.4 507 1340 NBW (n=1154)

Less than 12 years 6.5 5.1 8.2 64 2222 12 years 22.0 19.7 24.6 229 7502

More than 12 years 71.4 68.6 74.0 861 24303

PRAMS Data To Action: How Can PRAMS Data Be Used? PRAMS is a valuable source for data that were not previously available on health indicators for mothers and very young infants. In addition to supporting grant proposals and evaluations for a variety of public health programs, New Hampshire PRAMS data has proven valuable for some creative projects that are being developed by stakeholders to address emerging issues and challenges within the state. These projects serve as examples that demonstrate a wide range of possibilities for using PRAMS to enrich efforts to improve the health of mothers and babies across the state and beyond. Development of a Cell Phone Application for Pregnant and Parenting Women in Substance Addiction Programs In a culture that is increasingly dependent on technology as a primary communication tool, stakeholders strive to adapt to new generations and methods of communication. NH PRAMS developed state specific questions on access to and use of texting among New Hampshire women of childbearing age; these data demonstrate the potential for using technology to reach women for health related messaging. The Dartmouth Perinatal Addiction Treatment Program used the NH PRAMS data on texting and major life stressors to support a successful grant proposal to fund a pilot program for the development of a digital platform (cell phone application) in 2017. The platform will assist pregnant and parenting women who are in addiction treatment programs in maintaining and documenting adherence to their Plan of Safe Care (PSC) for their infants, as required by federal law. The results of this pilot will be used to support additional funding proposals; project leaders believe that this technology has the potential to transform approaches to PSC development nationally. Supporting Professional Development Opportunities for Providers Working with Patients on Tobacco Cessation In its ongoing efforts to improve tobacco cessation and treatment strategies, the New Hampshire Tobacco Prevention and Cessation Program (NH TPCP) developed a series of video learning modules in 2017 to educate providers in the best strategies to help patients quit tobacco use. NH TPCP used PRAMS data on smoking during the perinatal period to inform the creation of a specific module on the unique needs of pregnant and parenting women. The modules are now available online to meet the professional development needs of providers across the state. As NH PRAMS collects more years of data, the value to stakeholders increases with opportunities to track trends and emerging issues within the state, all with an eye toward using these data to develop and improve programs to address the health needs of mothers and infants and to support a healthy future for the citizens of New Hampshire. Are you using NH PRAMS data? Do you have questions about the data or how it might help you develop or improve your program? We would love to hear from you whether you have questions or a story about how you have used the data. Contact New Hampshire PRAMS: [email protected] / 603-271-2081


Using New Hampshire PRAMS Data The following programs have used PRAMS data to support their work, some for a one-time project and many on an ongoing basis: NH Governor's Commission on Alcohol and Drug Abuse Prevention Treatment and Recovery Data on tobacco and alcohol use and other substance misuse. To inform the Commission’s strategic plan.

NH Oral Health Program Data on oral health, income level, WIC enrollment. For evaluation, report writing, and for a presentation for Northern New England Perinatal Quality Improvement Network (NNEPQIN) conference, November 2017. NH Abusive Head Trauma Coalition Data on infant crying, advice to sooth crying baby, and stressors. For evaluation and planning; grant reporting. NH Tobacco Prevention and Cessation Program (TPCP) Data on texting and social media use, tobacco use, breastfeeding, income, Medicaid participation, birthweight, conversations with providers, and life stressors. To evaluate and plan new approaches to reach audience for the Quitline. To develop educational video modules for providers. Belknap-Merrimack CAP/WIC Data on flu vaccination during pregnancy (Data Brief) and the PRAMS factsheet. To include in packets for providers at WIC clinics. NH Chronic Disease Program Data on breastfeeding. To update report on breastfeeding in New Hampshire. Injury Prevention Center at Children’s Hospital at Dartmouth (CHAD)/ Injury Prevention Advisory Data on safety issues and provider conversation about soothing a crying infant. For annual Injury Prevention Report. Dartmouth Children's Environmental Health and Disease Prevention Research Center Data on advice from providers and testing of private wells; data on maternal characteristics. For research study on the association between maternal characteristics, provider patterns and water testing behavior. Dartmouth-Hitchcock Perinatal Addiction Program Data related to neonatal abstinence syndrome including stressors, alcohol and tobacco use, texting, income, and conversations with providers. To support a successful grant to develop a digital platform (cell phone application) to assist pregnant and parenting women in addiction treatment programs monitor and adhere to their Safe Plan of Care.

Community Health Institute/ Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) All PRAMS data. To complete a needs assessment for MIECHV. NH Maternal and Child Health Section Data on Safe Sleep practices, tobacco use, alcohol use, postpartum depression, oral health, stressors, folic acid use in pregnancy. For comparison to National Outcome Measures and National Performance Measures and to support grants for Safe Sleep programing, the Title V Maternal and Child Health Block Grant, the Home Visiting Program, and the Early Hearing Detection and Intervention (EHDI) program.

new hampshire 2013 - 2015 data book€¦ · new hampshire-specific questions in the phase 7 survey...

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